RESEARCH NOTE

INTERNATIONAL RESEARCH CONSENSUS: IDENTIFYING MILITARY RESEARCH PRIORITIES AND GAPS JAY R. HYDREN

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EDWARD J. ZAMBRASKI

U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts ABSTRACT Hydren, JR and Zambraski, EJ. International research consensus: Identifying military research priorities and gaps. J Strength Cond Res 29(11S): S24–S27, 2015—A multidisciplinary survey was administered to military performance researchers attending the Third International Conference on Soldier Physical Performance to obtain their opinions of the priority levels and importance of research topics related to soldier health and determinants of soldier physical performance. Respondents included 140 individuals from 22 different countries, of which 96% had at least a graduate degree and 79% were associated with a military organization. The top 5 highest importance/priority research topics were (a) physical demands in operational environments, (b) measuring physical performance/fitness, (c) musculoskeletal injury mitigation programs, (d) physical employment standards, and (e) physical strength-training programs. Of what individuals thought were their most important topics, 50% reported these were not currently being researched because of higher priorities, insufficient funding, or the lack of scientific expertise. A theme analysis of researchtopic areas that were important and not being researched indicated that physical employment standards and physical training studies related to soldiers’ health and performance are knowledge gaps. Although these experienced researchers had diverse backgrounds and were working on a wide array of research topics, there was a surprisingly clear consensus on what they thought were important topics that needed to be addressed in common between countries or militaries.

KEY WORDS topics, injury, training, performance, prevention, fitness, operational environments INTRODUCTION

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strong and comprehensive research effort is essential to meet the needs and address the issues of soldier health and physical performance. Because the missions and military demands of different countries may vary widely depending on their Address correspondence to Jay R. Hydren, [email protected]. 29(11S)/S24–S27 Journal of Strength and Conditioning Research Ó 2015 National Strength and Conditioning Association

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different needs, it is presumed that the research priorities of a given country or military may be unique. To determine the extent of the similarities, or differences, of research priorities for various military research programs, a survey was constructed and administered to scientists who attended the Third International Conference on Soldier Physical Performance (Third ICSPP), August 2014, Boston, MA. This meeting afforded a unique opportunity to survey military research groups from around the world. The intent was to ask expert researchers their opinions on what topics were the most important and whether their organizations were addressing these most critical issues. This information has the potential to reveal research gaps in common between countries and militaries around the world pertaining to soldier health and performance.

METHODS Experimental Approach to the Problem

To identify military research priorities and gaps, an electronic online survey was developed and sent to all the military researchers attending the Third ICSPP in August of 2014 in Boston, MA. Subjects

The survey went out to 313 conference attendees of the Third ICSPP. Procedures

An electronic survey (SurveyMonkey, www.surveymonkey. com, Palo Alto, CA) was developed containing a list of current research topics in the field of soldier health and physical performance. A group of 6 senior research scientists associated with military organizations helped formulate the survey and the list of topics; 2 of these individuals were from abroad. Demographic information about the researchers included country, military or civilian, job position, branch, highest level of education, and years of posteducation experience. The researchers evaluated a list of 37 specific research topic areas in 2 different ways: (a) on a Likert scale from 1 to 5 (“1,” unnecessary do not consider; “5,” highest importance/priority) and (b) a ranking of the top 5 topic areas. In addition, they were asked if there were important research areas not included in the list. They were also asked if their most important topic area was being addressed, and if not, why (other higher priorities, lack of funding, or lack of scientific expertise)?

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Journal of Strength and Conditioning Research Statistical Analyses

To assess the commonality of high-priority research, potential research gaps and if there was a consensus, each research topic area was scored in rank order 3 different ways: (a) average Likert scale rating, (b) number of 5s received on the Likert scale (highest importance/priority), and (c) sum of top 5 overall rankings, where 5 points were given to the first topic, 4 for the second, 3 for the third, 2 for the forth and, 1 for the fifth, and no points were given for unranked topics. For each of the 3 analyses, a rank order was developed and ranks were scored;

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such that each of the rank order was the score, and if there was a tie, topics were given the same score and numbering restarted at rank order. For example: first = 1, second = 2, tie for third = 3 for each, and fifth = 5. The 3 rank scores were summed for an overall score (sum of rank order), where a low score was equal to the most common and highest priority topic.

RESULTS Of the 313 Third ICSPP conference attendees who received the survey, 140 responded. The respondents had extensive

TABLE 1. Rank order of topics.

Research topic Physical demands in operational environments Measuring physical performance/fitness Musculoskeletal injuries: injury mitigation programs Physical employment standards Physical training programs: strength Physical training programs: high-intensity programs Soldier load impairing performance Physical training programs: endurance Musculoskeletal injuries: overuse injuries Physical demands in training environments Fitness of recruits Nutrition Gender integration within the military Soldier equipment impairing performance Cognitive function: resilience Effects of deployment(s) Environmental factors: heat Sleep Epidemiology (characterizing individuals, tracking pertinent medical information, injuries) Musculoskeletal injuries: stress fractures Male vs. female performance Musculoskeletal injuries: acute injuries Clinical research: diagnosing injuries that impair performance Clinical research: basis for return to duty decisions Cognitive function: motivation Clinical research: treatment of injuries that impair performance Clinical research: concussions Computational/predictive modeling of performance Environmental factors: altitude Environmental factors: cold Body composition of recruits Genetics (selection for performance, injury potential) Performance of National Guard/Reserve Troops (leave blank if no NG/R) Supplements: legal Endocrinological factors and performance Supplements: illegal Use of nonsteroidal anti-inflammatory drugs

Average rating (1–5)

Highest importance (no. of 5)

4.34 4.16 4.16 4.00 4.12 4.07 4.00 4.00 4.10 4.06 3.76 3.93 3.48 3.88 3.69 3.89 3.68 3.73 3.80

56 45 39 40 41 40 34 37 35 39 28 32 26 25 21 30 23 28 20

141 110 102 164 77 59 84 76 72 70 81 50 98 46 75 33 48 35 46

4 7 12 13 15 23 24 25 25 25 35 36 45 47 48 48 51 52 53

3.65 3.58 3.65 3.54

19 24 19 22

47 44 38 23

58 58 63 70

3.48 3.50 3.60

23 14 18

32 36 19

70 74 75

3.08 3.24 3.18 3.33 3.31 2.92 3.16

15 15 12 12 10 8 10

41 18 20 16 15 32 18

81 85 87 88 93 95 95

3.17 3.10 2.76 2.93

11 4 7 6

9 13 4 3

97 104 108 108

Top 5 Total score (sum of over all rank order)

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Identifying Military Research Priorities and Gaps experience with military research of 13.4 6 9.4 years (mean 6 SD), with a wide range (0–40 years). The expertise of the respondents was very high with 52% having a doctoral degree (PhD, EdD, ScD), 40% having a graduate degree (MS, MA), 4% whose highest level of education was an undergraduate degree (BS, BA), and 4% having a Medical Doctorate. The respondents were primarily scientists/ researchers (81%), with administrators making up 8%, soldier/airman/sailor 7%, clinicians 4%, and students accounting for 1%. Of the 140 respondents, 29% were military and 71% were civilian, and 79% were associated with a military organization. Branches represented by respondents included 49% Army, 4% Navy, 4% Air Force, 20% other, and 24% did not respond. Countries and responses from each included (n): the United States (58), Finland (12), Australia (7), United Kingdom (7), Brazil (6), France (5), Norway (5), Singapore (5), Sweden (5), Germany (4), the Netherlands (4), Belgium (3), Canada (3), Denmark (3), Chile (2), Israel (2), New Zealand (2), South Africa (2), Austria (1), Estonia (1), Scotland (1), and Switzerland (1). The 37 topics provided to the survey respondents and the rankings can be seen in Table 1. There was a remarkable consistency in the rankings determined by the different analyses. A theme analysis of the top 5 results suggests that topics related to operational environments were of the highest importance/priority. With the other top areas of research having clear links to this effort, for example, how to measure physical performance/fitness, mitigate injuries, and the setting of physical employment standards that are linked to the most demanding job tasks. Of what respondents listed as the most important topic, 50% of respondents reported that it was not being researched. The reasons stated included other high priorities, accounting for 26%; 15% said there is a lack of funding for the topic; and 8% stated that there was a lack of scientific expertise. Topics with 5 or more researchers feeling that their most important topics were not being addressed comprised: (a) physical employment standards, (b) periodization, (c) injury mitigation programs, (d) endurance physical training programs, (e) strength-training programs, and (f ) high-intensity training programs. Reasons provided for why these topics (listed above) are not being researched were primarily other higher priorities (14 respondents), lack of funding (7 respondents), and lack of expertise (6 respondents). In addition to the 37 topics, there were 82 answers to the question: “Please list any other areas/topics pertaining to Soldier physical performance that are not listed above, but you believe are important.” A theme analysis revealed that 67 of these further defined some aspect of the original 37 topics listed. Nine new topics were presented: periodization (accounted for 7), physiological monitoring, muscle physiology, soldier systems engineering, longevity of elite operators, decision making, tactical decision making by nonexperts,

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building physical and mental capabilities, and training and testing to prepare for deployment.

DISCUSSION The Third ICSPP meeting offered a unique opportunity to poll international military research scientists on what they thought were the most important needed areas of research pertaining to soldier physical performance. To date, the authors are unaware of attempts to survey senior military researchers on priorities and importance of topic areas for soldier health and performance. The resultant survey response rate of approximately 45% was substantial. As a group, the respondents represented a highly educated and experienced cohort. One of the most important findings was that there was a consensus on the most important issues, or gaps, although these researchers worked in a wide variety of areas (i.e., individuals simply did not rate their own area of research as being the most important or critical). There was clear agreement that the physical demands in the operational environment, measuring performance, musculoskeletal injuries, and physical training programs were considered to be the most important topic areas. Addressing the physical demands within operational garrison environments will present challenges. Historically, primarily for logistical reasons, studies of performance, injuries, and physical training programs have been conducted in the basic or advanced training environments. To quantitate the physical demands and associated musculoskeletal injuries within the operational setting will require unique capabilities and some reevaluation of priorities and processes. First, military leadership will need to acknowledge that this is an important need, and thus, grant access to soldiers while deployed. The requirements pertaining to “human use and research subjects” may need to be evaluated to make data collection in the “field” feasible. Increasing use of researchers embedded with the troops and the development of new noninvasive small sensors to measure biomechanical forces over long periods of time (e.g., weeks, months) will be essential. A clearer picture of the physical demands associated with military operations will then enable the development of appropriate and more individualized physical training programs. It is important to be aware of the limitations and scope of this survey. There may be bias in the sample as American researchers accounted for 41% of the sample with each of the other countries making up 9% or less of the sample. The analysis was repeated without U.S. data and the top 5 rankings were largely the same, with physical demands in operational environments remaining the number one research gap and strength-training programs, high intensity training programs, physical employment standards, and measuring physical performance/fitness rounded out the top 5. Another factor suggesting that the U.S. scientists’ input was not overly represented was that specific research

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Journal of Strength and Conditioning Research topics pertaining to U.S. Army soldier performance which are currently under discussion or in the news, such as male vs. female performance, body composition, and the use of supplements, received very low-priority scores (Table 1). Many reasons could explain why some areas received low rankings. This could be because institutes of health, private funding, or industry may be providing research support in these areas. Some researchers may feel that some topics have been thoroughly and adequately studied. Also, respondents may have considered what issues or problems apply to the greatest number of soldiers, and therefore solving these problems would have a significant positive impact on factors such as soldier readiness or medical costs. Although this meeting was the Third Congress on soldier performance, this survey was the first effort to obtain input from this international group of researchers. Should there be a Fourth Congress in 2017, it would be of value to conduct a similar survey to determine what changes or progress may have occurred in addressing what have been identified as top research priorities.

PRACTICAL APPLICATIONS Although there was a wide variety of research topics presented, this survey provided a consensus. Experienced military performance researchers from around the world identified the current top 5 highest importance/priority research topics as: (a) physical demands in operational environments, (b) measuring physical performance/fitness, (c) musculoskeletal injury mitigation programs, (d) physical

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employment standards, and (e) physical strength-training programs. However, 50% of respondents indicated that what they perceived to be the most important topic areas were not being addressed because of higher priorities, lack of funding, or the lack of scientific expertise. The topics of technology and psychology were also cited as being potentially important factors influencing soldier physical performance. There were similarities between topics considered important and not being researched, indicating that physical employment standards and physical training studies related to soldiers’ health and performance are considerable knowledge gaps.

ACKNOWLEDGMENTS The following individuals were instrumental in the development of the survey: B. Nindl, M. Sharp, N. Taylor, B. Jones, and H. Kyrolainen. The technical assistance and survey development provided by Ms. L. Walker is gratefully acknowledged. The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the Army or the Department of Defense. This research was supported by an appointment to the Student Research Participation Program and the Knowledge Preservation Program at the U.S. Army Medical Research Institution of Environmental Medicine administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and U.S. Army Medical Research and Materiel Command.

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International Research Consensus: Identifying Military Research Priorities and Gaps.

A multidisciplinary survey was administered to military performance researchers attending the Third International Conference on Soldier Physical Perfo...
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