Introduction

Musculoskeletal injuries (MSKI) sustained during military training and while performing the occupational role are a significant problem for international militaries.1 These injuries present a large, initial diagnostic and treatment healthcare burden, along with longer-term costs associated with rehabilitation, re-injury, chronic disability, discharge from service and associated compensation claims.2 Due to the downstream consequences of MSKI—for individuals and organisations—research has focused on MSKI mitigation programmes (MSKI-MP) aimed at reducing this poor health burden.3 Controlled research interventions applied in military settings have been shown to be effective in reducing injury occurrence4 and improving training outcomes. However, enduring benefits in the ‘real world’—when research controls and resources are removed—have been poor.3 Indeed, only one-third of clinical, evidenced-based injury mitigation programmes and interventions are fully translated into real-world settings.5

We have recently reported the barriers (and facilitators) to successful implementation and adoption of MSKI-MP for service personnel.3 These included: limited resources; competing military priorities; equipment-related factors; and, central to this editorial, lack of stakeholder engagement.3 Indeed, programme implementation is frequently suboptimal due to insufficient engagement among all knowledge users. In this context, knowledge users include practitioners and leaders (at all levels of military organisations) responsible for developing, implementing and evaluating MSKI-MP, as well as other programme end users. In military organisations, leaders are accustomed to giving orders, subordinates are accustomed to taking orders, such that routine communications are often unidirectional. Moreover, conflicting cultures, behaviours and beliefs among researchers, military leaders, practitioners and MSKI-MP end users are all likely to reduce compliance and adherence, ultimately impacting longer-term intervention fidelity and outcomes.1 Thus, successful MSKI-MP requires significant cultural and behaviour change, as well as an openness to accept challenge to deeply held beliefs.

Many interventions administered in military settings are not developed with the end user (ie, …