MILITARY MEDICINE, 169, 7:562, 2004 Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm in Army Bsic Comt Trining: Return to Trining, Grdution, nd 2-Yer Retention Gurntor: Keith G. Huret, MSPH MPT Contriutors: Keith G. Huret, MSPH MPT*; Joseph J. Knpik, ScD*; Jeffrey L. Lnge, PhD*; LTC Heidi A. Heckel, SP USA ; CPT Dn L. Covl, SP USA ; CPT Dvid H. Duplessis, SP USA Bsic trinees t Fort Jckson, South Crolin, who were unle to continue sic comt trining (BCT) ecuse of serious injury were ssigned to the Physicl Trining nd Rehilittion Progrm (PTRP). Between Jnury 3, 1998 nd July 24, 2001, 4,258 trinees were ssigned to the PTRP. Using retrospective cohort study design, return to trining nd BCT grdution rtes were evluted. PTRP grdutes were compred with mtched non-ptrp grdutes for 2-yer retention in the Army. More PTRP women thn men were dischrged from the PTRP (60% nd 48%, respectively, p 0.01). Of PTRP trinees returning to BCT, 10% nd 12% of men nd women, respectively, were dischrged from the Army compred with overll Fort Jckson dischrge rtes of 9% nd 15% for men nd women, respectively. Compring PTRP grdutes to mtched non-ptrp grdutes, there were no differences in 2-yer retention for men (14.9% nd 14.7%, respectively; p 0.93) or women (26.6% nd 30.1%, respectively; p 0.19). Despite the high dischrge rte in the PTRP, the BCT dischrge rte for trinees who successfully rehilitted ws similr to the overll dischrge rte t Fort Jckson. The 2-yer retention in service for PTRP trinees who grduted from BCT ws similr to tht of non-ptrp trinees. Introduction rmy sic comt trining (BCT) is chllenging 9-week A period during which new recruits develop sic soldier skills nd increse their physicl fitness. As result of the physicl chllenges of BCT, 15 to 37% of men nd 38 to 67% of women sustin t lest one injury. 1,2 In 1998 t Fort Jckson, South Crolin, the Army s lrgest BCT post, 3% of men nd 12% of women sustined n injury severe enough to e temporrily removed from trining. 3 Fort Jckson developed the Physicl Trining nd Rehilittion Progrm (PTRP) in 1995 to provide supervised rehilittion progrm for trinees with trumtic frcture, stress frcture, or other disling injury. Trinees with less serious injuries styed with their trining unit during their recovery. In Jnury 1998, the criteri for ssigning injured trinees to the *Directorte of Epidemiology nd Disese Surveillnce, U.S. Army Center for Helth Promotion nd Preventive Medicine, Aerdeen Proving Ground, MD 21010-5403. Womck Army Medicl Center, Fort Brgg, NC 28301. Commnder, B Compny, 46th Adjutnt Generl Bttlion, Fort Knox, KY 40121. Portions of this pper were presented t the Eighth Annul Recruit nd Trinee Helthcre Symposium, April 16, 2002, Towson, MD, nd t the Annul Conference of the Americn College of Sports Medicine, My 30, 2002, St. Louis, MO. The opinions or ssertions contined herein re the views of the uthors nd re not to e construed s officil or s reflecting the views of the Deprtment of the U.S. Army or the U.S. Deprtment of Defense. This mnuscript ws received for review in Mrch 2003 nd ccepted for puliction in July 2003. PTRP were revised. The new criteri directed tht ll trinees on limited duty (profile) for more thn 7 consecutive dys, ecuse of pin or the severity of the injury, e ssigned to the PTRP. This provided trinees with more pproprite setting in which to recover nd rehilitte from their injuries nd llowed the units to focus on their trining mission. With the new ssignment criteri, the numer of trinees in the PTRP incresed from dily verge of pproximtely 30 trinees efore 1998, to more thn 300 trinees. The other BCT posts (Fort Knox, Kentucky; Fort Leonrd Wood, Missouri; Fort Sill, Oklhom; nd Fort Benning, Georgi) egn PTRPs in 1999, ut ech post estlished its own criteri for ssigning injured trinees. Once PTRP trinee recovers from the injury, completes the rehilittion process, nd meets minimum physicl fitness stndrd, he/she returns to BCT. During 1998, 60% of PTRP men nd 48% of PTRP women t Fort Jckson returned to BCT fter completing their rehilittion. The mjority of those who did not return to trining were dischrged for motivtionl nd performnce resons. 3 At the other BCT posts (excluding Fort Knox, where no dt were ville), the dischrge rte for PTRP trinees rnges from 34 to 46% for men nd from 49 to 59% for women (our unpulished dt). The PTRP dischrge rte t Fort Jckson hs een closely monitored since 1998 nd hs een reported previously. 3 However, the dischrge rte of PTRP trinees who successfully return to BCT nd the retention in service of PTRP trinees who grdute from BCT hve not een evluted. The ojectives of this study were to determine the dischrge rtes for trinees in the PTRP t Fort Jckson, to compre the BCT dischrge rtes for PTRP trinees who return to trining nd non-ptrp trinees undergoing uninterrupted BCT, nd to compre the 2-yer retention of PTRP nd non-ptrp grdutes. This study ws undertken s result of forml tsker from the U.S. Army Medicl Commnd to the U.S. Army Center for Helth Promotion nd Preventive Medicine in June 2001. Methods A retrospective cohort study design ws used in this study. The Physicl Therpy Clinic, Moncrief Army Community Hospitl, Fort Jckson, South Crolin, provided dt on ll BCT trinees ssigned to the PTRP etween Jnury 3, 1998 nd July 24, 2001. Dt elements included ge, sex, dte ssigned to the PTRP, dte of deprture from the PTRP, nd finl sttus of ech trinee t deprture from the PTRP (returned to trining or dischrged from the Army). A totl of 4,258 trinees (men, n 1,228; women, n 3,030) were ssigned to the PTRP during the oservtion period. Of these, 72 men nd 227 women were still Militry Medicine, Vol. 169, July 2004 562 Copyright (c) Assocition of Militry Surgeons of the U.S. All rights reserved.
Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm 563 in the PTRP when dt were collected nd were excluded from ll nlyses. The finl smple included 3,959 PTRP trinees (men, n 1,156; women, n 2,803). Dischrges from the PTRP Trinees in the PTRP successfully completed their rehilittion nd returned to BCT or were dischrged from the Army. Dischrges for PTRP trinees were grouped into four ctegories. These included entry level seprtions (ELS) for performnce or motivtion prolems, existed prior to service (EPTS) dischrges when preexisting physicl or medicl condition ws excerted y trining, medicl dischrges when serious injury sustined in BCT prevented the trinee from returning to BCT, nd other dischrges. The length of sty in the PTRP ws clculted using the dte ssigned to the PTRP nd the dte of deprture from PTRP. The lengths of sty in the PTRP for trinees who returned to trining nd those who were dischrged were compred using two-wy nlysis of vrince (sex dischrge sttus). The proportions of PTRP men nd women who were dischrged from the Army were compred using the 2 test of proportions. The univrite ssocitions of ge nd sex with dischrge sttus were determined using the reltive risk (RR) nd 95% confidence intervl (CI). Age ws evluted s ctegoricl vrile with four ge groups: 17 to 19, 20 to 24, 25 to 29, nd 30 yers nd older. A liner trend in RR y ge group ws lso evluted. The ge nd sex ssocitions with dischrge sttus were further evluted in multivrite model tht included ge nd sex using logistic regression techniques. The ge-sex interction in the multivrite model ws evluted y including n ge-sex product term. Becuse there ws evidence of n ge-sex interction, the RR nd 95% CI were determined for ech ctegory of ge nd sex, with the referent ctegory eing men in the oldest ge group. The RR nd 95% CI were lso evluted compring ech ge group of women to the oldest ge group of women. From Jnury 3, 1998 to Octoer 22, 1998, injured trinees were given the choice of eing ssigned to the PTRP or eing dischrged from the Army (ecuse they could not continue trining ecuse of their injury). Beginning Octoer 23, 1998, trinees were no longer given this choice. Rther, the BCT units ssigned ll injured trinees to the PTRP unless there hd een significnt performnce or motivtion issues efore the injury. In this ltter cse, the trinees were dischrged from the Army. Other thn this chnge implemented Octoer 23, 1998, no other significnt ltertions to the PTRP process were instituted during the period Octoer 23, 1998 to April 23, 1999. To determine whether the dischrge rte ws influenced y this chnge, the dischrge rte of PTRP trinees entering the PTRP etween Jnury 3, 1998 nd Octoer 22, 1998 (group 1, men: n 266; women: n 544) ws compred with the dischrge rte for two other groups of PTRP trinees. One group (group 2, men 221; women: n 572) included ll PTRP trinees who entered the PTRP etween Octoer 23, 1998 nd April 23, 1999, wheres the other group (group 3, men: n 391; women: n 863) included those who entered the PTRP etween Jnury 3, 1999 nd Octoer 22, 1999. The intervl for group 3 ws selected to compre similr timefrme to group 1 (Jnury through Octoer in two successive yers, 1998 nd 1999), therey minimizing demogrphic nd sesonl differences tht my exist in trinees entering BCT t different times of the yer. 4 The 2 test of proportions ws used to compre differences in the proportion of dischrged trinees in group 1 to those of groups 2 nd 3. Dischrges from BCT (PTRP Trinees Who Returned to Trining) A totl of 1,719 PTRP trinees (men, n 602; women, n 1,117) returned to trining from the PTRP etween Jnury 3, 1998 nd July 24, 2001. These trinees successfully completed trining nd grduted from BCT or were dischrged from the Army. Ntionl Gurd or Army Reserve trinees (n 607) were excluded from further nlyses ecuse of differences in their militry contrcts nd type of service fter grdution from BCT. The Army Trining Requirements nd Resources System (ATRRS) provided the dischrge sttus (dischrged vs. grduted) for the Active Army PTRP trinees who returned to trining nd the grdution dte for those who grduted. ATRRS dt could not e otined or ws incomplete for 10 trinees who returned to trining. These trinees were excluded from nlysis. The finl smple for whom ATRRS dt were received ws 1,102 trinees (men, n 408; women, n 694). The univrite nd multivrite ssocitions of sex nd ge with dischrge from BCT were evluted s descried previously for dischrge from the PTRP. Dischrges during the First 2 Yers fter BCT Grdution For PTRP trinees who grduted from BCT (PTRP grdutes), the dischrge rte during the first 2 yers fter grdution ws compred with the dischrge rte for mtched BCT grdutes who hd not een ssigned to the PTRP (non-ptrp grdutes). Only PTRP trinees who grduted from BCT t lest 2 yers efore dt collection (August 31, 2001) were included (men, n 194; women, n 277). The Defense Medicl Surveillnce System identified three mtched non-ptrp grdutes for ech PTRP grdute. Mtching ws sed on the following criteri: ge ( 3 yers), sex, rce, ttended BCT t Fort Jckson, strt dte of BCT ( 30 dys), nd ctive Army sttus. Grdution sttus nd the grdution dte of the mtched non-ptrp grdutes were confirmed y ATRRS, s hd een done for PTRP grdutes. The finl mtching of PTRP grdutes nd nongrdutes ws 1:2.9 for men (non-ptrp grdutes, n 565) nd 1:2.8 for women (non-ptrp grdutes, n 767). For the PTRP nd non-ptrp grdutes, dditionl Defense Medicl Surveillnce System dt included current sttus in the Army (dischrged vs. still on ctive duty) s of August 31, 2001 nd the dte of dischrge for those who were dischrged. Kpln-Meier survivl nlysis techniques were used to compre retention in the Army for the PTRP grdutes nd mtched non-ptrp grdutes during their first 2 yers fter grdution. The survivl time (dys on ctive duty) for those who were dischrged during their first 2 yers ws determined y sutrcting the grdution dte from the dischrge dte. Differences in the survivl function of the PTRP nd non-ptrp grdutes were compred using the log rnk test. The 2 test of proportions ws used to compre the proportion of PTRP grdutes nd non-ptrp grdutes who were dischrged. Survivl nlysis techniques were lso used to compre the 2-yer retention for PTRP trinees who entered the PTRP during the three time periods descried previously compring group 1 to groups Militry Medicine, Vol. 169, July 2004 Copyright (c) Assocition of Militry Surgeons of the U.S. All rights reserved.
564 Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm 2 nd 3 (group 1, men: n 97; women: n 142; group 2, men: n 54; women: n 90; group 3, men: n 77; women: n 87). SPSS, version 10.1, or Epi Info, version 6.1, ws used for ll sttisticl nlyses. Results Dischrges from the PTRP Of the 3,959 trinees who deprted the PTRP, 56.6% were dischrged from the Army nd 43.4% returned to trining. The gretest proportion of dischrges ws ELS (63.5%), with the reminder involving EPTS dischrges (20.5%), medicl dischrges (9.5%), nd other dischrges (6.5%). The men length of sty in the PTRP y sex nd dischrge sttus is presented in Tle I. The men length of sty tended to e longer for men nd women who were dischrged. Women styed in the PTRP significntly longer thn men, regrdless of their dischrge sttus. In the two-wy nlysis of vrince, the min effects for dischrge sttus nd sex were significnt (p 0.03 nd p 0.01, respectively), ut no sex-dischrge sttus interction ws seen (p 0.54). Tle II presents the univrite ssocitions of sex nd ge with risk of dischrge from the Army while in the PTRP. Overll, women were more likely thn men to e dischrged. Younger trinees exhiited higher risk (greter RR) of dischrge thn older trinees. There ws significnt interction etween sex nd ge in the multivrite model (p 0.01). Thus, Tle III presents the comined effects of sex nd ge on dischrge. Compred with the oldest men, younger men were more likely to e dischrged from the PTRP, ut this did not rech the 95% CI. Compred with the oldest men, the youngest two ge groups of women were more likely to e dischrged. In univrite nlysis of the ge-dischrge sttus considering women seprtely, younger women hd higher risk of eing dischrged thn older women (RR, 1.61; 95% CI, 1.35,1.92). Tle IV presents the comprison of the PTRP dischrge rte for the groups of PTRP trinees who entered PTRP during the three different time periods. Among men, the proportion of dischrged trinees tended to e lower in group 1 compred with group 2, nd ws lower in group 1 compred with group 3. Among women, the proportion of dischrged trinees from group 1 ws lower thn from groups 2 or 3. Dischrges from BCT Of the PTRP trinees who returned to BCT, 9.6% of men nd 12.4% of women were dischrged from BCT. The univrite ssocitions of sex nd ge with dischrge sttus from BCT re presented in Tle V. Although women tended to e t higher risk of eing dischrged thn men, nd younger ge groups tended to e t lower risk of eing dischrged thn the oldest ge TABLE I LENGTH OF STAY (MEAN DAYS SD) IN THE TRP FOR MEN AND WOMEN BY DISCHARGE STATUS Returned to Trining (dys) Dischrged (dys) Men 65 43 70 52 Women 75 49 78 54 TABLE II DISCHARGES FROM THE ARMY FOR TRAINEES IN THE PTRP AND THE UNIVARIATE ASSOCIATIONS OF SEX AND AGE WITH DISCHARGE Recruits in PTRP Dischrged (n [%]) RR (95% CI) Sex Men (n 1,156) 554 (47.9%) 1.00 Women (n 2,803) 1,686 (60.1%) 1.26 (1.17, 1.34) Age (yers) 17 19 (n 1,849) 1,135 (61.4%) 1.48 (1.28, 1.72) c 20 24 (n 1,325) 741 (55.9%) 1.35 (1.16, 1.57) 25 29 (n 496) 244 (49.2%) 1.19 (1.01, 1.41) 30 (n 273) 113 (41.4%) 1.00 RR (95% CI) of dischrge from the Army. Age vrile ws missing for 16 trinees, 7 of whom were dischrged. c p trend for ge 0.01. TABLE III RR OF DISCHARGE FROM THE ARMY BY AGE AND SEX FOR TRAINEES IN THE PTRP Age (yers) Men Women 17 19 1.15 (0.88, 1.51) 1.55 (1.20, 2.01) 20 24 1.15 (0.87, 1.51) 1.40 (1.08, 1.81) 25 29 1.06 (0.78, 1.45) 1.20 (0.91, 1.58) 30 1.00 0.96 (0.71, 1.31) RR (95% CI). group, these differences did not rech the 95% CI. There ws no interction etween sex nd ge (p 0.59) in the multivrite model for dischrge sttus. Dischrges during the First 2 Yers fter BCT Grdution Tle VI compres the dischrge rtes within 2 yers of BCT grdution for the PTRP grdutes nd non-ptrp grdutes. Differences etween the two groups were not sttisticlly significnt for men or women. However, women in oth groups hd significntly higher dischrge rtes thn the men. Figures 1 (men) nd 2 (women) present the survivl functions for 2-yer retention in the Army for the PTRP grdutes compred with the mtched non-ptrp grdutes. There were no differences in the survivl functions for men or women. Tle VII compres the dischrge rtes within 2 yers of grdution for the three groups of grdutes who entered the PTRP during the three periods. Women in group 1 tended to e dischrged t lower rte thn women in groups 2 or 3. In the 2-yer survivl nlyses compring mle PTRP trinees in groups 1 nd 2 or groups 1 nd 3, there were no differences (p 0.95 nd p 0.74, respectively). Figures 3 nd 4 compre the survivl function for women in group 1 with the survivl functions for women in groups 2 nd 3. Discussion This study found tht pproximtely 48% of men nd 60% of women who entered the PTRP were dischrged from the Army. Younger women ( 25 yers) were t higher risk of eing dischrged thn men, wheres older women ( 25 yers) returned to trining t rte similr to men. For those returning to BCT fter PTRP, 90% of PTRP men nd 88% of women who returned Militry Medicine, Vol. 169, July 2004 Copyright (c) Assocition of Militry Surgeons of the U.S. All rights reserved.
Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm 565 TABLE IV COMPARISON OF DISCHARGE RATES FOR TRAINEES ASSIGNED TO THE PTRP DURING THREE TIME PERIODS Group 1: Jnury 3 1998 Octoer 22 1998 Group 2: Octoer 23 1998 April 23 1999 p Group 3: Jnury 3 1998 Octoer 22 1999 p Men 41.4% 48.0% 0.11 52.9% 0.04 Women 50.9% 60.8% 0.001 64.0% 0.001 Intervl during which trinee rrived t PTRP. p compring the proportion of dischrged trinees from group 1 vs. group 2. c p compring the proportion of dischrged trinees from group 1 vs. group 3. TABLE V UNIVARIATE ASSOCIATIONS OF SEX AND AGE WITH DISCHARGE FROM THE ARMY FOR TRAINEES WHO RETURNED TO BCT FROM THE PTRP Ctegory Dischrged (n [%]) RR (95% CI) Sex Men (n 408) 39 (9.6%) 1.00 Women (n 694) 86 (12.4%) 1.30 (0.91, 1.86) Age (yers) 17 19 (n 502) 51 (10.2%) 0.64 (0.37, 1.13) 20 24 (n 300) 37 (12.3%) 0.78 (0.43, 1.39) 25 29 (n 218) 24 (11.0%) 0.69 (0.37, 1.30) 30 (n 82) 13 (15.9%) 1.00 RR (95% CI) of dischrge from BCT. TABLE VI COMPARISON OF DISCHARGE RATES WITHIN 2 YEARS AFTER GRADUATION FROM BCT FOR PTRP GRADUATES AND NON-PTRP GRADUATES PTRP Grdutes Non-PTRP Grdutes p Men 14.9% 14.7% 0.83 Women 26.6% 30.1% 0.19 p 0.01 0.01 p compring PTRP grdutes nd non-ptrp grdutes mong men or women. p compring men nd women within PTRP grdutes or non-ptrp grdutes. Fig. 1. Two-yer survivl compring PTRP grdutes nd non-ptrp grdutes (men). Fig. 2. Two-yer survivl compring PTRP grdutes nd non-ptrp grdutes (women). to trining successfully completed BCT nd grduted. Furthermore, the 2-yer retention in the Army for PTRP grdutes ws similr to tht of non-ptrp grdutes. The reltively high dischrge rte for trinees while in the PTRP t Fort Jckson is mtter tht requires further discussion. The PTRP dischrge rte t three of the other BCT posts (Forts Leonrd Wood, Sill, nd Benning) tends to e lower thn t Fort Jckson (see Introduction ). However, these other posts llow injured trinees on limited duty to remin in the BCT units rther thn ssigning them to the PTRP unless they hve frctures (trumtic or stress) or other disling injuries. The BCT unit then ensures tht injured trinees follow their limited duty restrictions nd ttend rehilittion throughout the recovery period, which my lst severl weeks or longer. In 1998 t Fort Jckson, the most serious injuries (trumtic nd stress frctures) were dischrged from the PTRP t lower rte compred with other injuries. 3 The lower dischrge rtes for serious injuries my contriute to the lower PTRP dischrge rtes t the other posts ecuse PTRP ssignment is limited to these injury types. Dt re not ville t these other posts on the dischrge rte of other injured trinees who remined in their units rther thn eing ssigned to the PTRP. The resons for the high dischrge rtes for PTRP men nd women t Fort Jckson re likely to e complex nd multifctoril. Some insights my e gined y compring the group of trinees ssigned to PTRP when they could choose to go to the Militry Medicine, Vol. 169, July 2004 Copyright (c) Assocition of Militry Surgeons of the U.S. All rights reserved.
566 Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm TABLE VII DISCHARGE RATE WITHIN 2 YEARS OF GRADUATION FROM BCT FOR PTRP GRADUATES ASSIGNED TO THE PTRP DURING THREE TIME PERIODS Group 1: Group 2: Group 3: Jnury 3 1998 Octoer 22 1998 Octoer 23 1998 April 23 1999 p c Jnury 1 1998 Octoer 22 1999 Men 16.5% 16.7% 0.69 14.3% 0.98 Women 26.1% 37.7% 0.06 37.9% 0.09 p 0.01 vlue compring men nd women. Period during which trinees rrived t PTRP. c p compring the proportion of trinees who were dischrged from groups 1 nd 2. d p compring the proportion of trinees who were dischrged from groups 1 nd 3. p d Fig. 3. Two-yer survivl compring women ssigned to the PTRP etween Jnury 3, 1998 nd Octoer 22, 1998 (group 1) to women ssigned etween Octoer 23, 1998 nd April 23, 1999 (group 2). Fig. 4. Two-yer survivl compring women ssigned to the PTRP etween Jnury 3, 1998 nd Octoer 22, 1998 (group 1) to women ssigned etween Jnury 3, 1999, nd Octoer 22, 1999 (group 3). PTRP or e dischrged from the Army (group 1) to the groups of trinees tht were utomticlly ssigned to the PTRP regrdless of their personl choice (groups 2 nd 3). When femle trinees hd choice, the dischrge rte from the PTRP ws lower thn when trinees did not hve choice. These dt suggest tht choosing to enter the PTRP (possily reflecting greter personl motivtion nd commitment towrd completing BCT) my e n indictor for successful PTRP completion nd return to BCT. The less serious injuries in Fort Jckson s PTRP my lso represent trinees who hve higher risk for dischrge ecuse of low physicl fitness or low motivtion to continue trining. 5,6 Younger ge, especilly mong women, ws ssocited with n incresed risk of eing dischrged from the Army rther thn returning to BCT from the PTRP. It is possile tht older ge is ssocited with greter mturity nd improved coping skills, oth of which would improve the trinees ility to succeed in the PTRP nd return to BCT. Older ge my lso e ssocited with greter personl motivtion nd commitment to complete the trining process. Sixty-four percent of PTRP dischrges were for ELS. From personl experience reviewing dischrge records t Fort Jckson, this dischrge ctegory includes dischrges for mny types of personl prolems generlly ctegorized s eing relted to poor performnce or lck of motivtion to continue trining. These prolems my relte to the trinees inility to cope with the psychologicl stressors relted to BCT or eing ssigned to the PTRP. BCT is very chllenging nd stressful period for trinees. When recruits egin BCT, mny nxiously nticipte grduting in 9 weeks. Trinees estlish strong onds with peers s they lern to depend upon one nother for support, temwork, nd ultimtely for success. When n injury occurs, there is stigm relted to eing perceived y cdre nd other trinees s eing roke. Trinees ssigned to PTRP experience dditionl stressors s they re seprted from their peer support nd trining cdre, nd they relize tht their time to complete BCT will e incresed. PTRP trinees must lso cope with the pin nd functionl limittions of eing injured, the chllenges of rehilittion, nd the need to reestlish peer reltionships nd fit in t the PTRP nd when returning to BCT. These incresed psychologicl stressors my overwhelm some tht might hve coped with the norml stressors of BCT. These stressors my e importnt fctors contriuting to the low returnto-trining rte for PTRP trinees. Personl chrcteristics tht hve een found to e ssocited with eing dischrged from militry sic trining re, most likely, lso ssocited with dischrge from the PTRP. These include femle gender, lower eduction, 5,6 history of physicl 7,8 Militry Medicine, Vol. 169, July 2004 Copyright (c) Assocition of Militry Surgeons of the U.S. All rights reserved.
Outcomes of Fort Jckson s Physicl Trining nd Rehilittion Progrm 567 or sexul 7,9 use, hving predicted shorter militry creer upon rrivl t sic trining, 5 rting oneself s more reellious thn peers, 5 feeling overwhelmed y the demnds of the trining environment, lck of confidence in their ility to cope with stress, 10 higher nger levels, 11 lower levels of optimism towrd grdution, 8 nd lower physicl fitness on entry. 6 In consonnce with these dt, we found tht women were more likely thn men to e dischrged from PTRP ut did not mesure the other fctors noted here. To provide sense of how the BCT dischrge rtes from this study compre to the overll BCT ttrition rte t Fort Jckson, the ttrition rtes for ctive Army trinees t Fort Jckson were otined from the U.S. Army Trining nd Doctrine Commnd for fiscl yers 1998 through 2001. Becuse these rtes include PTRP trinees, they could not e sttisticlly compred with the PTRP dischrge rtes from this study. However, generl comprison of these rtes is possile. The overll Fort Jckson dischrge rtes were 9% nd 15% for men nd women, respectively. These rtes re similr to the dischrge rtes from this study for PTRP men nd women who returned to trining (10% nd 12%, respectively). It hs een suggested necdotlly tht PTRP trinees my more likely e dischrged during BCT or erly in their militry creer ecuse of reinjury. Although this study did not determine the resons for dischrge from BCT or lter in the service, it does indicte tht fter returning to BCT, PTRP men nd women re no more likely to e dischrged thn their non-ptrp counterprts. Future Directions Further efforts regrding the PTRP should e directed t three res. First, the 30% of dischrges for medicl resons is understndle, ut the 64% of dischrges for performnce nd motivtion prolems should e more fully ddressed. Administering questionnire to newly ssigned PTRP trinees to ssess intrinsic motivtion my ssist in developing future interventions to reduce ttrition. Interventions should e evluted tht more effectively ddress the psychologicl stressors relted to eing injured nd ssigned to the PTRP, nd tht re relted to incresed risk for dischrge. Second, comprison of the outcomes from the different PTRPs should e undertken. This would include evluting the dvntges nd disdvntges for keeping injured soldiers in the BCT unit compred with ssigning them to the PTRP, nd the impct on the BCT trining unit when injured trinees re kept in the unit compred with ssigning them to the PTRP. Third, cost-enefit nlysis of the PTRP should e performed to fully ssess the overll enefit of the progrm in terms of cost svings for injury-relted ttrition. Conclusion Forty-eight percent of men nd 60% of women in the PTRP t Fort Jckson were dischrged from the Army while in the PTRP. Two-thirds of dischrges from the PTRP were for lck of motivtion or poor performnce. The dischrge rte for PTRP trinees ws lowest when injured trinees were given choice of eing ssigned to the PTRP or eing dischrged from the Army. The dischrge rtes for PTRP men nd women who returned to BCT compred fvorly with the overll dischrge rtes t Fort Jckson. The 2-yer retention of PTRP grdutes ws similr to tht of non-ptrp grdutes. Acknowledgments We thnk ll stff ssigned to the Physicl Therpy Clinic, Moncrief Army Community Hospitl, from 1998 through 2001 for their significnt contriutions to the PTRP nd the collection of the primry dt used for this study. References 1. Jones BH, Knpik JJ: Physicl trining nd exercise-relted injuries: surveillnce, reserch nd injury prevention in militry popultions. Sports Med 1999; 2: 111 25. 2. Knpik JJ, Shrp MA, Cnhm ML, et l: Injury incidence nd injury risk fctors mong U.S. Army sic trinees, Ft. Jckson, SC 1998. Epidemiologicl consulttion report 29-HE-8370-98. 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