Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement

Garrett S Bullock; Joanne L Fallowfield; Sarah J de la Motte; Nigel Arden; Ben Fisher; Adam Dooley; Neil Forrest; John J Fraser; Alysia Gourlay; Ben R Hando; Katherine Harrison; Debra Hayhurst; Joseph M Molloy; Phillip M Newman; Eric Robitaille; Deydre S Teyhen; Jeffrey M Tiede; Emma Williams; Sandra Williams; Damien Van Tiggelen; Joshua J Van Wyngaarden; Richard B Westrick; Carolyn A Emery; Gary S Collins; Daniel I Rhon

doi:10.12688/f1000research.152514.1

Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement

F1000Res. 2024 Sep 11:13:1044. doi: 10.12688/f1000research.152514.1. eCollection 2024.

Authors

Garrett S Bullock^{1

2

3}, Joanne L Fallowfield⁴, Sarah J de la Motte^{5

6}, Nigel Arden^{1

7}, Ben Fisher^{8

9}, Adam Dooley¹⁰, Neil Forrest⁹, John J Fraser^{6

11}, Alysia Gourlay¹², Ben R Hando^{13

14}, Katherine Harrison^{15

16}, Debra Hayhurst¹⁷, Joseph M Molloy¹⁸, Phillip M Newman¹⁹, Eric Robitaille^{20

21}, Deydre S Teyhen²², Jeffrey M Tiede¹⁴, Emma Williams²³, Sandra Williams²⁴, Damien Van Tiggelen²⁵, Joshua J Van Wyngaarden^{13

26}, Richard B Westrick²⁷, Carolyn A Emery²⁸, Gary S Collins²⁹, Daniel I Rhon^{6

14}

Affiliations

¹ Centre for Sport, Exercise, and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK.
² Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
³ Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁴ Institute of Naval Medicine, Directorate of People and Training, Royal Navy, Hampshire, UK.
⁵ Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.
⁶ Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
⁷ Medical Research Council (MRC), Environmental Epidemiology Unit, University of Southampton, Southampton, England, UK.
⁸ Defence Primary Healthcare, Headquarters Surgeon General, London, UK.
⁹ Army Health, Army Headquarters, London, UK.
¹⁰ Human Sciences Programme, Defence Science & Technology, New Zealand Defence Force, Auckland, New Zealand.
¹¹ Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA.
¹² Joint Health Command, Department of Defence, Australian Capital Territory, Australia.
¹³ Army-Baylor University, Waco, Texas, USA.
¹⁴ Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
¹⁵ Defense Statistics Health, Ministry of Defence, London, UK.
¹⁶ Director General, Finance, Ministry of Defence, London, UK.
¹⁷ Headquarters Defence Medical Services, Strategic Command, Ministry of Defence, London, UK.
¹⁸ Formerly at the Physical Performance Service Line, Office of the Army Surgeon General, Falls Church, Virginia, USA.
¹⁹ Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia.
²⁰ Teaching Stream Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
²¹ 31 CF H Svcs C Detachment, Department of National Defence, Meaford, Canada.
²² Defense Health Network, National Capital Region, Defense Health Agency, Bethesda, MD, USA.
²³ Second Health Brigade, Australian Army, Sydney, Australia.
²⁴ Defence Rehabilitation, Ministry of Defence, London, UK.
²⁵ Belgium Armed Forces, Brussels, Belgium.
²⁶ 59th Medical Wing, Joint Base San Antonio - Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas, USA.
²⁷ Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.
²⁸ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
²⁹ Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK.

Abstract

Background: The objective was to summarize the methodology used to reach consensus for recommended minimum data elements that should be collected and reported when conducting injury surveillance research in military settings. This paper summarizes the methodology used to develop the international Minimum Data Elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement.

Methods: A Delphi methodology was employed to reach consensus for minimum reporting elements. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge/information gaps and 3) establish future research priorities. The team then led a sequential three-round Delphi consensus survey, including relevant stakeholders from militaries around the world, and then conducted asynchronous mixed knowledge user meeting to explore level of agreement among subject matter experts. Knowledge users, including former and current military service members, civil servant practitioners, and global-wide subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored each question on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5).

Results: Literature review and surveys helped informed the scope of potential variables to vote on. Three rounds were necessary to reach minimum consensus. Ninety-five, 65 and 42 respondents participated in the first, second and third rounds of the Delphi consensus, respectively. Ultimately, consensus recommendations emerged consisting of one data principle and 33 minimum data elements.

Conclusions: Achieving consensus across relevant stakeholders representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature.

Keywords: Consensus; Delphi; Implementation Science; Investigative Techniques; Military; Military Medicine; Sports Medicine; Wounds and Injuries.

MeSH terms

Common Data Elements
Consensus
Delphi Technique*
Humans
Military Personnel*
Musculoskeletal Diseases / epidemiology
Musculoskeletal System / injuries
Population Surveillance / methods
Surveys and Questionnaires

Grants and funding

This work was sponsored by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness organization (Department of Physical Medicine and Rehabilitation), Center for Health Services Research, and Consortium for Health and Military Performance at the Uniformed Services University (Award: HU00012320034) and the US Department of Defense. Additional funding was provided by United Kingdom Defence Primary Healthcare, HQ Surgeon General, and Institute of Naval Medicine, Navy Command, United Kingdom.