Does Self-efficacy Predict Outcomes Among U.S. Military Academy Cadets During Initial Entry Training?

Study Overview
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Brief Summary
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Background: Lower back injuries are a common occurrence in athletes, sports programs, and in the military (Bengtsson, 2018; Lovalekar, 2021). The Army's new fitness test includes a three-repetition maximum deadlift, and this inclusion has raised concern amongst servicemembers and healthcare workers due to the association between deadlifts and lower back injuries. There is debate amongst researchers about the role of deadlift form in lower back injury prevention, specifically related to flexion of the spine (Sjoberg, 2020). Purpose: The purpose of this study is to investigate the effect of low back pain education (either cautionary regarding injury risk or reassuring regarding spine resiliency) on deadlift performance (weight lifted), and if this education has an effect on self-efficacy and perceived spine vulnerability. Participants: Participants will be incoming new cadets at the United States Military Academy (USMA). Inclusion criteria are cadets age 17-26 (cadets under the age of 18 are legally emancipated therefore able to consent), those participating in the ACFT, and speak and understand English. Study Design: This study will be a randomized controlled trial with parallel design and 1:1 allocation ratio. The investigators plan to use cluster randomization. There will be three groups- control, cautionary, reassuring (Jackson, 2005). The investigators are also planning a prospective cohort study to assess self-efficacy, injury, and performance over time. Procedures: Data will be collected at the United States Military Academy during the summer of 2022 during cadet basic training. Shortly after new cadets arrive at USMA, the investigators will gather demographic and initial self-efficacy information. The randomized control element of this study will occur before and during the maximum deadlift (MDL) of the Army Combat Fitness Test (ACFT). At the start of cadet basic training, investigators will randomly allocate each company of cadets into one of three groups (three companies per group.) The investigator will administer the education (cautionary, reassuring, or control) shortly prior to cadets taking the MDL, and will collect results after the ACFT. The cautionary education is similar to standard information provided to many servicemembers before the start of an ACFT or a maximum deadlift.

Detailed Description
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Background: Musculoskeletal injuries (MSKIs) are the leading cause of nondeployability, lost duty days (LDD), medical encounters, military discharge, and disability in the United States Military. (Lovalekar, 2021). Ironically, the leading causes of MSKIs are same activities that leaders deliberately conduct to develop physical resilience: running, foot marching, other physical fitness training activities (besides running) and work-related tasks (Lovalekar, 2021). Purpose: The purpose of this study is to learn about relationships between self-efficacy, injury and physical/tactical performance. The investigators also plan to assess the effect of low back pain education (either cautionary regarding injury risk or reassuring regarding spine resiliency) on deadlift performance (weight lifted), and if this education has an effect on self-efficacy and perceived spine vulnerability. Participants: Participants will be incoming new cadets at the United States Military Academy (USMA). Inclusion criteria are cadets age 17-26 (cadets under the age of 18 are legally emancipated therefore able to consent), those participating in the ACFT, and speak and understand English. Study Design: This study will be a randomized controlled trial with parallel design and 1:1 allocation ratio. The investigators plan to use cluster randomization. There will be three groups- control, cautionary, reassuring (Jackson, 2005). The investigators are also planning a prospective cohort study to assess self-efficacy, injury, and performance over time. Procedures: Data will be collected at the United States Military Academy during the summer of 2022 during cadet basic training. Shortly after new cadets arrive at USMA, the investigators will gather demographic and initial self-efficacy information. The randomized control element of this study will occur before and during the maximum deadlift (MDL) of the Army Combat Fitness Test (ACFT). At the start of cadet basic training, researchers will randomly allocate each company of cadets into one of three groups (three companies per group.) The researchers will administer the education (cautionary, reassuring, or control) shortly prior to cadets taking the MDL, and will collect results after the ACFT. The cautionary education is similar to standard information provided to many servicemembers before the start of an ACFT or a maximum deadlift.

Official Title
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Does Self-efficacy Predict Outcomes Among U.S. Military Academy Cadets During Initial Entry Training?

Conditions
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Low Back Pain, Musculoskeletal Injury

Intervention / Treatment
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* Behavioral: Deadlift Form Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All incoming US Military Academy cadets, attending cadet basic training in summer 2022. Exclusion Criteria: Unable to communicate in English; unable to participate in deadlift event.

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Mixed Design with Time Repeated and Group Between-Factor, Randomized Controlled Trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cautionary<br>The group will receive a message regarding potential risk for spine injury before the tested task. | Behavioral: Deadlift Form Education<br>* The education will include information about the lumbar spine as it relates to a deadlift. The researchers will administer this education shortly prior to participants taking a strength test.<br>|
| Experimental: Reassuring<br>This group will receive a message regarding spine resiliency before the tested task. | Behavioral: Deadlift Form Education<br>* The education will include information about the lumbar spine as it relates to a deadlift. The researchers will administer this education shortly prior to participants taking a strength test.<br>|
| No Intervention: Control<br>This group will not receive education before the tested task. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Deadlift weight lifted | Amount of weight lifted for three repetitions | Day 1/Post-intervention | 
| Perceived spine vulnerability questionnaire | Ease of which participants believe the back can be injured. Questions based on Back Pain Attitude Questionnaire | Day 1/Pre-Test | 
| Perceived spine vulnerability questionnaire | Ease of which participants believe the back can be injured. Questions based on Back Pain Attitude Questionnaire | Day1/Post-Test | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Deadlift Self-Efficacy Questionnaire | Confidence in ability to deadlift | Day 1/Post-Test | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nocebo, Self-Efficacy