Musculoskeletal injuries and dropout in the military: Epidemiology, prediction and prevention

The objectives of the research in this thesis were to provide insight in epidemiologic data of musculoskeletal injuries and dropout of training in the Netherlands Armed Forces, make efforts to predict individual dropout probabilities and to evaluate which prevention interventions may be worth implementing in the military. Ultimately this thesis aims to contribute to training soldiers sustainably. In the second chapter we describe the epidemiology and injury-dependent financial burden of musculoskeletal injuries in active-duty personnel in the Netherlands Armed Forces. In the third chapter we describe the epidemiology of musculoskeletal injuries in military recruits and the impact in terms of dropout of elite military training. The fourth chapter presents the derivation and validation of a prediction algorithm for dynamically updated estimation of conditional dropout probabilities for Marine recruit training. The fifth chapter is a clinimetrics study and describes the psychometric qualities of a Dutch grit scale to be used in Marine recruits. Subsequently we describe in chapter six the association between baseline grit levels and attrition from Marine recruit training. Chapter seven presents the results of a pilot trial evaluating the effects of an injury and attrition preventive program. In chapter eight we present a systematic review of the literature including the effectives of exercise programs to reduce the risk of all musculoskeletal injuries in military populations generally. In chapter nine we address the challenges and possibilities to apply key evidence-informed principles of load management to minimize the risk of injury to basic military training.