Sports Medicine Training Room Clinic Model for the Military

Abstract

A transition from traditional problem-based clinics to the Sports Medicine and Reconditioning Team (SMART) clinic model was completed by January 2009 at Marine Corps Base Camp Lejeune. The SMART clinic model allows for more patients to be seen and enhances coordinated care between providers. The objective of this research is to show the advantages of implementing a training room team approach for the care of musculoskeletal injuries in active duty members by comparing the number of patients seen, the number of limited duty (LIMDU) periods, the number of physical evaluation boards (PEBs), and the percentage of orthopedic referrals. Electronic medical records for patients seen at sports medicine clinics between January 1, 2007 and December 31, 2010 were reviewed. Naval Hospital Camp Lejeune provided a database of patients placed on LIMDU and PEB from 2007 through 2010. Fifty-eight and twenty-four percent more encounters occurred in 2009 and 2010, respectively, than that in 2007. The percentage of LIMDU referred for PEB in 2010 was reduced to 9% compared to that in 2007. In conclusion, the SMART clinic model allows for more patients to be seen and a reduction in the percentage of patients recommended for PEB from LIMDU.

Description and Rate of Musculoskeletal Injuries in Air Force Basic Military Trainees, 2012−2014

“…Although these efforts have received many reports of success and have resonated with commanders, [22][23][24] published data on the efficacy of ATs in this role are lacking. 25 A prospective controlled trial will soon be conducted at JBSA-Lackland to obtain data on the effectiveness of ATs in increasing on-time graduation rates and decreasing costs related to musculoskeletal injuries.…”

Rationale for Embedded Musculoskeletal Care in Air Force Training and Operational Units

“…[3][4][5][6][7] Given that musculoskeletal injury (MSK-I) accounts for the greatest number of medical visits and lost duty time in military populations, [8][9][10] there is an obvious need for effective and efficient methods of primary and secondary injury prevention, as well as timely and proficient assessment, treatment, and rehabilitation of these prevalent injuries. To address the MSK-I burden in service members, SMTs have begun to be adapted for military settings over the past decade in numerous Army, 11 Navy, 12 and Marine 13 units. Although these 3 services have already invested significant funding and personnel to create SMTs of varying compositions, similar efforts in the USAF have generally lagged behind (with the exception of small-scale efforts in the Air Force Special Operations Command).…”

“…14 Early examples of this need being addressed are the sports medicine injuryprevention initiative in US Marine Corps Basic Training 16 and the Navy model of SMART clinics, which both began in the early 2000s. 12,16 The use of SMART clinics has decreased the number of limited-duty days and the number of sailors referred for musculoskeletal-related medical discharge. 12 Thus, SMART clinics are now commonplace at a large number of naval bases worldwide.…”

“…12,16 The use of SMART clinics has decreased the number of limited-duty days and the number of sailors referred for musculoskeletal-related medical discharge. 12 Thus, SMART clinics are now commonplace at a large number of naval bases worldwide. Army examples of military SMTs include the Warrior Athletic a Attrition data obtained from training squadron record-keeping system.…”

“…18 Key to the success of these embedded SMT examples are certified athletic trainers in embedded clinics backed by sports medicine physicians and support staff. 12 These models offer rapid access to a team of dedicated sports medicine providers who can coordinate on-site care in a timely manner. Although the ideal balance of providers (eg, certified athletic trainers, strength and conditioning coaches, exercise physiologists, clinical and operational psychologists, sports nutritionists, physical and occupational therapists, and sports medicine physicians) varies in each setting, a multidisciplinary model including certified athletic trainers, physical therapists, and sports medicine physicians is critical to success (J. Biery, written communication, May 2015; S. J. Blivin, written communication, May 2015).…”