Prediction of exertional lower extremity musculoskeletal injury in tactical populations: protocol for a systematic review and planned meta-analysis of prospective studies from 1955 to 2018.

BACKGROUND: Musculoskeletal injuries (MSI) represent more than half of all injuries in tactical populations (i.e., military service and public safety workers including police, firefighters, emergency medical services (EMS)). Most lower extremity MSIs result from physical exertion during training, occupational tasks, and recreation. Such exertional lower extremity injuries (ELEI) produce a significant human and financial cost. Accordingly, significant efforts have been made to identify sensitive, specific, and reliable predictors of ELEI. There is a need to synthesize and evaluate the predictive value of risk factors for ELEI while addressing the influence of occupation, sex, exposure, injury characteristics, and study quality. Therefore, the purpose of this systematic review and planned meta-analysis is to evaluate risk factors for ELEI in tactical populations.

METHODS: After the development of a search strategy, comprehensive searches will be conducted in MEDLINE, EMBASE, Cochrane, and CINAHL databases. Articles will be screened with a multi-user process and delimited to prospective comparative cohort studies that directly measure injury occurrence in the target population(s). Extracted data will be synthesized and assessed for reporting bias, meta-bias, and overall quality, with subgroup analyses to determine the influence of participant, injury, and exposure characteristics in addition to study quality.

DISCUSSION: This systematic review and planned meta-analysis will comprehensively evaluate ELEI risk factors. Information gained will inform injury prevention protocols, facilitate the use of improved measurements, and identify requirements for future research.

TRIAL REGISTRATION: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 3 Jan 2018 (registration number CRD42018056977 ).