Musculoskeletal Injury Concealment in the Reserve Officers' Training Corps: A Survey of Cadets' Reporting Behaviors

Background Among service members, musculoskeletal injuries threaten military readiness and place a substantial burden on medical and financial resources. Emerging research suggests that service members regularly conceal injuries, especially in training environments. The Reserve Officers' Training Corps (ROTC) is a critical training environment for future U.S. military commissioned officers. Training activities expose cadets to a high risk of injury while in the ROTC. The purpose of this study was to explore injury-reporting behaviors in cadets and factors associated with injury concealment. Materials and Methods We invited Army, Air Force, and Naval cadets from six host universities participating in officer training to complete an online, self-reported survey regarding injury reporting and concealment. Cadets answered questions about pain or injuries experienced during officer training. Survey questions pertained to an injury's anatomic location, onset, severity, functional limitations, and whether or not the injury had been reported. Cadets also selected factors that influenced the decision to report or conceal injuries from predetermined lists in a "choose any" fashion. A series of chi(2) tests of independence compared the relationship between injury reporting and other injury characteristics for each individual injury. Results One hundred fifty-nine cadets (121 Army, 26 Air Force, and 12 Naval) completed the survey. Eighty-five cadets disclosed a total of 219 injuries. Two-thirds of injuries (144/219) were concealed. Twenty-six percent of participants (22/85) reported all injuries, whereas the remainder (63/85, 74%) had at least one concealed injury. In relation to injury reporting/concealment, there was a weak association with injury onset (chi(2)(1) = 4.24, P = .04, V = 0.14), a moderate association with anatomic location (chi(2)(12) = 22.64, P = .03, V = 0.32), and relatively strong associations with injury severity (chi(2)(3) = 37.79, P < .001, V = 0.42) and functional limitations (chi(2)(3) = 42.91, P < .001, V = 0.44). Conclusions Two-thirds of injuries went unreported in this sample of ROTC cadets. Functional limitations, symptom severity, and injury onset may be the largest factors that influence the decision to report or conceal musculoskeletal injuries. This study establishes the foundation for researching injury reporting in cadets and adds to the existing military evidence on the topic.