Outcomes of Embedded Athletic Training Services Within United States Air Force Basic Military Training

Context: Musculoskeletal injury is the leading cause of attrition from military training. Objective: To assess the effect of an embedded athletic training musculoskeletal care model within a basic military training unit. Design: Cluster randomized trial. Setting: United States Air Force Basic Military Training, Joint Base San Antonio-Lackland. Patients or Other Participants: Military recruits randomly assigned to 1 of 3 training squadrons, 2 control and 1 experimental, between January 2016 and December 2018. Intervention(s): 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. Main Outcome Measure(s): 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. Results: 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]). Conclusions: An embedded athletic training musculoskeletal care model outperformed usual care across operational, medical, and fiscal outcomes.y