Lower rank, which indicated socioeconomic status, was also a predictor of poor health outcomes among service members, according to the research that appears in the Journal of Bone and Joint Surgery and was led by a former Army Major who served in Afghanistan.
Researchers followed 4,122 soldiers aged 18-52 from the start of their 15-month deployment to Iraq during the surge of 2006 until four years after their return. The strongest predictors of inability to continue serving in the military were instances of musculoskeletal conditions (including fractures and chronic knee, shoulder, spine and back pain); a psychological diagnosis and rank.
The study is believed to be among the first to follow a large series of American patients with musculoskeletal trauma from the time before their injury in order to determine predictors of health outcomes.
"Our findings indicate a substantial burden in deployment-related injuries and disability that result from exposure to the combat environment. They also highlight influences that may impede a person's ability to return to work after similar injuries in the civilian sector, " says lead author Andrew J. Schoenfeld, M.D., M.Sc., a Robert Wood Johnson Clinical Scholar at the Department of Orthopaedic Surgery at the U-M Medical School and VA Ann Arbor Healthcare System.
"We examined a brigade of diverse individuals who offer a rich sample of a civilian American demographic. This group not only included infantry fighters but also doctors, truck drivers, cooks, mechanics, legal clerks and others with various positions with the Army- and most of the injuries weren't related to combat."
Post-traumatic stress disorder, low back pain and traumatic brain injury topped the list of reasons soldier were found unfit to continue service by the military's Physical Evaluation Board (PEB).
Authors say psychological disorders and lower social status may actually hinder an individual's recovery from a musculoskeletal injury.
"Our findings suggest that trauma from the incident that caused the injury may not only have long-lasting negative mental health effects but may also impede the physical recovery itself," says Schoenfeld, who is also a member of the Institute for Healthcare Policy and Innovation.
"In the civilian world, people may experience the same kind of injuries from events such as car or motorcycle accidents. Recollection of the accident that caused the injury, witnessing a loved one get hurt or killed or complications stemming from the injury may also be triggers for psychological issues that cause difficulties for recovery."
One hundred sixty survivors in the study had sustained a musculoskeletal injury from combat while 587 had a non-combat musculoskeletal injury. Another 331 surviving soldiers sustained war trauma, with 36 percent of combat-related injuries involving the head and neck.
Schoenfeld spent four years on active duty with the U.S. Army and served in Afghanistan as the clinical director of the Medical Evaluation Board at Fort Bliss Texas. He was also the director of orthopaedic research for the William Beaumont Army Medical Center/Texas Tech University Health Sciences Center Orthopaedic Residency Program.
"The model that we developed, including the identification of behavioral health conditions and social status as potent predictors of poor health consequences following musculoskeletal injury, has the potential to improve the care of trauma patients in both the military and civilian setting," he says.
Additional Authors: Gens P Goodman, DO; Robert E. Burks, Ph.D., Michael A. Black, D.Sc; James H. Nelson, M.D.; Philip J. Belmont, Jr., M.D.
Reference: "The Influence of Musculoskeletal Conditions, Behavioral Health Diagnoses and Demographic Factors on Injury-related Outcome in a High-Demand Population," Journal of Bone and Joint Surgery, July 2, 2014.
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