{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T13:59:37Z","timestamp":1782655177822,"version":"3.54.5"},"reference-count":28,"publisher":"National Athletic Trainers' Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>Musculoskeletal injury is the leading cause of attrition from military training.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the effect of an embedded athletic training musculoskeletal care model within a basic military training unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cluster randomized trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>United States Air Force Basic Military Training, Joint Base San Antonio\u2014Lackland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients or Other Participants<\/jats:title><jats:p>Military recruits randomly assigned to 1 of 3 training squadrons, 2 control and 1 experimental, between January 2016 and December 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention(s)<\/jats:title><jats:p>A sports medicine care model was established in 1 squadron by embedding 2 certified athletic trainers overseen by a sports medicine fellowship-trained physician. The athletic trainers diagnosed and coordinated rehabilitation as the primary point of contact for recruits and developed interventions with medical and military leadership based on injury trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>Recruit attrition from basic training due to a musculoskeletal injury. Secondary outcomes were all-cause attrition, on-time graduation, rates of lower extremity injury and stress fracture, rates of specialty care appointments, and fiscal costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Recruits in the athletic training musculoskeletal care arm experienced 25% lower musculoskeletal-related attrition (risk ratio = 0.75 [95% CI = 0.64, 0.89]) and 15% lower all-cause attrition (risk ratio = 0.85 [95% CI = 0.80, 0.91]), translating to a net saving of more than $10 million. The intervention reduced the incidence of lower extremity stress fracture by 16% (rate ratio = 0.84 [95% CI = 0.73, 0.97]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An embedded athletic training musculoskeletal care model outperformed usual care across operational, medical, and fiscal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.4085\/1062-6050-0498.19","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T18:49:52Z","timestamp":1609181392000},"page":"134-140","source":"Crossref","is-referenced-by-count":28,"title":["Outcomes of Embedded Athletic Training Services Within United States Air Force Basic Military Training"],"prefix":"10.4085","volume":"56","author":[{"given":"Reid","family":"Fisher","sequence":"first","affiliation":[{"name":"University of the Incarnate Word, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shandra","family":"Esparza","sequence":"additional","affiliation":[{"name":"University of the Incarnate Word, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel S.","family":"Nye","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Gottfredson","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary T.","family":"Pawlak","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Leo","family":"Cropper","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Casey","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juste","family":"Tchandja","sequence":"additional","affiliation":[{"name":"Trainee Health Surveillance, Joint Base San Antonio (JBSA)-Lackland, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"de la Motte","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryant J.","family":"Webber","sequence":"additional","affiliation":[{"name":"United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"key":"2021021722095960400_i1062-6050-56-2-134-b01","unstructured":"Department of Defense instruction: qualification standards for enlistment, appointment, and induction. Executive Services Directorate Web site. https:\/\/www.esd.whs.mil\/Portals\/54\/Documents\/DD\/issuances\/dodi\/130426p.pdf.Published October 26, 2018. Accessed August 16,2019."},{"key":"2021021722095960400_i1062-6050-56-2-134-b02","doi-asserted-by":"crossref","unstructured":"Bartlett CG, Stankorb S. Physical performance and attrition among U.S. Air Force trainees participating in the basic military training fueling initiative. Mil Med. 2017; 182(1): e1603\u2013 e1609. doi: 10.7205\/MILMED-D-15-00451.","DOI":"10.7205\/MILMED-D-15-00451"},{"key":"2021021722095960400_i1062-6050-56-2-134-b03","unstructured":"Surveillance snapshot: illness and injury burdens, recruit trainees, active component, U.S. Armed Forces, 2018. MSMR . 2019; 26(5): 27."},{"key":"2021021722095960400_i1062-6050-56-2-134-b04","doi-asserted-by":"crossref","unstructured":"Reis JP, Trone DW, Macera CA, Rauh MJ. Factors associated with discharge during Marine Corps basic training. Mil Med. 2007; 172(9): 936\u2013 941. doi: 10.7205\/milmed.172.9.936.","DOI":"10.7205\/MILMED.172.9.936"},{"key":"2021021722095960400_i1062-6050-56-2-134-b05","doi-asserted-by":"crossref","unstructured":"Knapik JJ, Canham-Chervak M, Hauret K, Hoedebecke E, Laurin MJ, Cuthie J. Discharges during U.S. Army basic training: injury rates and risk factors. Mil Med. 2001; 166(7): 641\u2013 647.","DOI":"10.1093\/milmed\/166.7.641"},{"key":"2021021722095960400_i1062-6050-56-2-134-b06","doi-asserted-by":"crossref","unstructured":"Nye NS, Pawlak MT, Webber BJ, Tchandja JN, Milner MR. Description and rate of musculoskeletal injuries in Air Force basic military trainees, 2012\u20132014. J Athl Train. 2016; 51(11): 858\u2013 865. doi: 10.4085\/1062-6050-51.10.10.","DOI":"10.4085\/1062-6050-51.10.10"},{"key":"2021021722095960400_i1062-6050-56-2-134-b07","unstructured":"The Air Force Independent Duty Medical Technician Program: AF Instruction 44-103. Department of the Air Force Web site. https:\/\/static.e-publishing.af.mil\/production\/1\/af_sg\/publication\/afi44-103\/afi44-103.pdf. Published August 20, 2018. Accessed February 13,2020."},{"key":"2021021722095960400_i1062-6050-56-2-134-b08","unstructured":"Lee D, Armed Forces Health Surveillance Center (AFHSC). Stress fractures, active component, U.S. Armed Forces, 2004\u20132010. MSMR. 2011; 18(5): 8\u2013 11."},{"key":"2021021722095960400_i1062-6050-56-2-134-b09","doi-asserted-by":"crossref","unstructured":"Kupferer KR, Bush DM, Cornell JE, et al. Femoral neck stress fracture in Air Force basic trainees. Mil Med. 2014; 179(1): 56\u2013 61. doi: 10.7205\/MILMED-D-13-00154.","DOI":"10.7205\/MILMED-D-13-00154"},{"key":"2021021722095960400_i1062-6050-56-2-134-b10","doi-asserted-by":"crossref","unstructured":"Curell AM, Nye NS, Webber BJ, Pawlak MT, Boden BP. Treatment and prognosis of high- and low-risk Kaeding grade II bone stress injuries. Transl J Am Coll Sports Med. 2019; 4(15): 114\u2013 118.","DOI":"10.1249\/TJX.0000000000000089"},{"key":"2021021722095960400_i1062-6050-56-2-134-b11","doi-asserted-by":"crossref","unstructured":"Nye NS, Covey CJ, Sheldon L, et al. Improving diagnostic accuracy and efficiency of suspected bone stress injuries. Sports Health. 2016; 8(3): 278\u2013 283. doi: 10.1177\/1941738116635558.","DOI":"10.1177\/1941738116635558"},{"key":"2021021722095960400_i1062-6050-56-2-134-b12","doi-asserted-by":"crossref","unstructured":"Larson MC, Renier CM, Konowalchuk BK. Reducing lost workdays after work-related injuries: the utilization of athletic trainers in a health system transitional work program. J Occup Environ Med. 2011; 53(10): 1199\u2013 1204. doi: 10.1097\/JOM.0b013e31822cfab3.","DOI":"10.1097\/JOM.0b013e31822cfab3"},{"key":"2021021722095960400_i1062-6050-56-2-134-b13","unstructured":"Zimmerman GR. Industrial medicine and athletic training: cost-effectiveness in the non-traditional setting. J Athl Train. 1993; 28(2): 131\u2013 136."},{"key":"2021021722095960400_i1062-6050-56-2-134-b14","doi-asserted-by":"crossref","unstructured":"Nicolello TS, Pecha FQ, Omdal RL, Nilsson KJ, Homaechevarria AA. Patient throughput in a sports medicine clinic with the implementation of an athletic trainer: a retrospective analysis. Sports Health. 2017; 9(1): 70\u2013 74. doi: 10.1177\/1941738116676452.","DOI":"10.1177\/1941738116676452"},{"key":"2021021722095960400_i1062-6050-56-2-134-b15","doi-asserted-by":"crossref","unstructured":"Knapik JJ, Graham B, Cobbs J, et al. The Soldier-Athlete Initiative: Program Evaluation of the Effectiveness of Athletic Trainers Compared to Musculoskeletal Action Teams in Initial Entry Training, Fort Leonard Wood, June 2010\u2013December 2011 . Aberdeen Proving Ground, MD: Army Public Health Command;2012.","DOI":"10.21236\/ADA586863"},{"key":"2021021722095960400_i1062-6050-56-2-134-b16","doi-asserted-by":"crossref","unstructured":"Brawley S, Fairbanks K, Nguyen W, Blivin S, Frantz E. Sports medicine training room clinic model for the military. Mil Med. 2012; 177(2): 135\u2013 138. doi: 10.7205\/milmed-d-11-00331.","DOI":"10.7205\/MILMED-D-11-00331"},{"key":"2021021722095960400_i1062-6050-56-2-134-b17","unstructured":"Pizzi A, Sefton J. Warrior athletic training: unexpected benefits of army-university collaborations. Infantry. 2012; 101(2): 47\u2013 48."},{"key":"2021021722095960400_i1062-6050-56-2-134-b18","unstructured":"Athletic trainers: Texas Administrative Code: Title 16, Part 4, Chapter 110. Office of the Texas Secretary of State Web site. https:\/\/texreg.sos.state.tx.us\/public\/readtac$ext.ViewTAC?tac_view=4&ti=16&pt=4&ch=110. Accessed August 16,2019."},{"key":"2021021722095960400_i1062-6050-56-2-134-b19","unstructured":"Athletic training education competencies. 5th ed. Commission on Accreditation of Athletic Training Education Web site. https:\/\/caate.net\/wp-content\/uploads\/2014\/06\/5th-Edition-Competencies.pdf. Accessed August 20, 2019."},{"key":"2021021722095960400_i1062-6050-56-2-134-b20","unstructured":"Athletic training services: an overview of skills and services performed by certified athletic trainers. National Athletic Trainers' Association Web site. https:\/\/www.nata.org\/sites\/default\/files\/GuideToAthleticTrainingServices.pdf. Published January 2010. Accessed August 20,2019."},{"key":"2021021722095960400_i1062-6050-56-2-134-b21","unstructured":"World Health Organization. International Classification of Diseases. Tenth Revision. Geneva, Switzerland: World Health Organization;1992."},{"key":"2021021722095960400_i1062-6050-56-2-134-b22","doi-asserted-by":"crossref","unstructured":"Nye NS, Carnahan DH, Jackson JC, et al. Abdominal circumference is superior to body mass index in estimating musculoskeletal injury risk. Med Sci Sports Exerc. 2014; 46(10): 1951\u2013 1959. doi: 10.1249\/MSS.0000000000000329.","DOI":"10.1249\/MSS.0000000000000329"},{"key":"2021021722095960400_i1062-6050-56-2-134-b23","doi-asserted-by":"crossref","unstructured":"Lee CH, Huang GS, Chao KH, Jean JL, Wu SS. Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg. 2003; 123(10): 527\u2013 533. doi: 10.1007\/s00402-003-0579-8.","DOI":"10.1007\/s00402-003-0579-8"},{"key":"2021021722095960400_i1062-6050-56-2-134-b24","doi-asserted-by":"crossref","unstructured":"Pihlajamaki HK, Ruohola JP, Kiuru MJ, Visuri TI. Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 2006; 88(9): 1989\u2013 1997. doi: 10.2106\/JBJS.E.00505.","DOI":"10.2106\/JBJS.E.00505"},{"key":"2021021722095960400_i1062-6050-56-2-134-b25","doi-asserted-by":"crossref","unstructured":"Webber BJ, Trueblood WE, Tchandja JN, Federinko SP, Cropper TL. Concurrent bilateral femoral neck stress fractures in a military recruit: a case report. Mil Med. 2015; 180(1): e134\u2013 e137. doi: 10.7205\/MILMED-D-14-00289.","DOI":"10.7205\/MILMED-D-14-00289"},{"key":"2021021722095960400_i1062-6050-56-2-134-b26","unstructured":"Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version Web site. www.OpenEpi.com. Updated April 6, 2013. Accessed July 31,2020."},{"key":"2021021722095960400_i1062-6050-56-2-134-b27","doi-asserted-by":"crossref","unstructured":"Cohen J. A power primer. Psychol Bull. 1992; 112(1): 155\u2013 159. doi: 10.1037\/0033-2909.112.1.155.","DOI":"10.1037\/0033-2909.112.1.155"},{"key":"2021021722095960400_i1062-6050-56-2-134-b28","unstructured":"Fitness program: AF Instruction 36-2905. Department of the Air Force Web site. https:\/\/static.e-publishing.af.mil\/production\/1\/af_a1\/publication\/afi36-2905\/afi36-2905.pdf. Published August 27, 2015. Accessed February 13,2020."}],"container-title":["Journal of Athletic Training"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/jat\/article-pdf\/56\/2\/134\/2774829\/i1062-6050-56-2-134.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/jat\/article-pdf\/56\/2\/134\/2774829\/i1062-6050-56-2-134.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T18:58:19Z","timestamp":1749668299000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/56\/2\/article-p134.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,28]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,12,28]]},"published-print":{"date-parts":[[2021,2,1]]}},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-0498.19","relation":{},"ISSN":["1062-6050"],"issn-type":[{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2020,12,28]]}}}