{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:03:51Z","timestamp":1780322631473,"version":"3.54.1"},"reference-count":14,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Mil Health"],"accepted":{"date-parts":[[2019,1,2]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82\u2009000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot\/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%).<\/jats:p>\n                    <jats:p>Several factors that slowed an individual\u2019s recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units.<\/jats:p>\n                    <jats:p>The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jramc-2018-001109","type":"journal-article","created":{"date-parts":[[2019,2,2]],"date-time":"2019-02-02T12:39:10Z","timestamp":1549111150000},"page":"312-317","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["20 Armoured Infantry Brigade downgrade study: epidemiology of principal conditions and plugging leaks in the rehabilitation pipeline"],"prefix":"10.1136","volume":"166","author":[{"given":"James","family":"Papworth","sequence":"first","affiliation":[{"name":"Military Admin Office, Army Personnel Centre, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Osborne","sequence":"additional","affiliation":[{"name":"Defence Postgraduate Medical Deanery, Defence Medical Services Whittington, Lichfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M A","family":"Shimmings","sequence":"additional","affiliation":[{"name":"Defence Postgraduate Medical Deanery, Defence Medical Services Whittington, Lichfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C C S","family":"Roberts","sequence":"additional","affiliation":[{"name":"Defence Postgraduate Medical Deanery, Defence Medical Services Whittington, Lichfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,2,2]]},"reference":[{"key":"2026052804352043000_166.5.312.1","unstructured":"GOV.UK , 2015. National security strategy and strategic defence and security review 2015. Available: https:\/\/www.gov.uk\/government\/publications\/national-security-strategy-and-strategic-defence-and-security-review-2015 [Accessed 10 Sep 2018]."},{"key":"2026052804352043000_166.5.312.2","unstructured":"MOD (Ministry of Defence) . 2017 UK Armed forces monthly service personnel statistics 1 october. London, 2017."},{"key":"2026052804352043000_166.5.312.3","unstructured":"Forces Network , 2017. \u201cAlmost 18,000 British army soldiers not fit to be deployed to all war zones\". Available: https:\/\/www.forces.net\/news\/almost-18000-british-army-soldiers-not-fit-be-deployed-all-war-zones [Accessed 10 Sep 18]."},{"key":"2026052804352043000_166.5.312.4","unstructured":"Lester D . A fifth of British troops are too unfit to fight, warns former armed forces chief. London: Daily Express, 2018."},{"key":"2026052804352043000_166.5.312.5","unstructured":"CFA (Commander Field Army) . Health and deployability directive. Andover: Field Army Headquarters, 2017."},{"key":"2026052804352043000_166.5.312.6","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-148-03-03"},{"key":"2026052804352043000_166.5.312.7","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2016-000657"},{"key":"2026052804352043000_166.5.312.8","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2017-000784"},{"key":"2026052804352043000_166.5.312.9","unstructured":"Army , 2018. \"New physical fitness standards for combat roles\". Available: https:\/\/www.army.mod.uk\/news-and-events\/news\/2018\/09\/new-physical-fitness-standards-for-combat-roles\/ [Accessed 22 Sep 18]."},{"key":"2026052804352043000_166.5.312.10","unstructured":"GOV.UK , 2015. \u201cNumber of recorded None-freezing cold (NFCI) Injuries for the UK armed forces 2010 \u2013 2015. Defence statistics (Health)\". Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/482974\/PUBLIC_1448967672.pdf [Accessed 22 Sept 18]."},{"key":"2026052804352043000_166.5.312.11","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-150-03-01"},{"key":"2026052804352043000_166.5.312.12","unstructured":"Department of Manning (Army) (DM(A)) . Pulhheems administration pamphlet. Andover, 2017."},{"key":"2026052804352043000_166.5.312.13","unstructured":"QRH UAP . Project lazarus. Personal communication, 2018."},{"key":"2026052804352043000_166.5.312.14","unstructured":"2 LANCS . Functional PT. Personal communication, 2017."}],"container-title":["BMJ Military Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2018-001109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:01:44Z","timestamp":1780318904000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2018-001109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,2]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,9,24]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/jramc-2018-001109"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2018-001109","relation":{},"ISSN":["2633-3767","2633-3775"],"issn-type":[{"value":"2633-3767","type":"print"},{"value":"2633-3775","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,2]]}}}