Predicting Upper Quadrant Musculoskeletal Injuries in the Military: A Cohort Study
KRISTYN E. CAMPBELL, ERIC C. PARENT, DANIEL J. CRUMBACK, JACQUELINE S. HEBERT
Abstract
PURPOSE: This study aimed to identify characteristics and movement-based tests that predict upper quadrant musculoskeletal injury (UQI) in military personnel over a 12-month follow-up. METHODS: A prospective observational cohort study of military members (n = 494; 91.9% male) was conducted. Baseline predictors associated with UQI were gathered through surveys and movement-based tests. Survey data included demographic information, injury history, and biosocial factors. Movement-based tests include the following: Y Balance Tests (YBT), Functional Movement Screen, Selective Functional Movement Assessment lumbar multisegmental mobility, modified-modified Schober, side bridge, ankle mobility, modified Sorensen, and passive lumbar extension. Self-reported UQI was collected through monthly online surveys, and 87% completed the follow-up. Univariate associations were determined between potential predictors and UQI. A forward, stepwise logistic regression model was used to identify the best combination of predictors for UQI. RESULTS: Twenty-seven had UQI. Univariate associations existed with three demographic (smoking, >1 previous UQI, baseline upper quadrant function ≤90%), three pain-related (Selective Functional Movement Assessment rotation, side bridge, hurdle step), and six movement-based variables (YBT upper quarter (UQ) superolateral worst score ≤57.75 cm, YBT-UQ composite worst score ≤81.1%, failed shoulder clearance, Sorenson <72.14 s, in-line lunge total score <15, and in-line lunge asymmetry >1). Smoking, baseline upper quadrant function ≤90%, and YBT-UQ composite score ≤81.1% predicted UQI in the logistic regression while controlling for age and sex. Presenting two or more predictors resulted in good specificity (85.6%; odds ratio, 4.8; 95% confidence interval, 2.2-10.8), and at least one predictor resulted in 81.5% sensitivity (odds ratio, 3.2; 95% confidence interval, 1.2-8.7). CONCLUSIONS: A modifiable movement-based test (YBT-UQ), perceived upper limb function, and smoking predicted UQI. A specific (two or more) and sensitive (at least one predictor) model could identify persons at higher risk.