Content Validity of Level Two of the Royal Air Force Aircrew Conditioning Programme

+Gz Exposure and Flight Duty Limitations

BACKGROUND: High +G_z exposure is known to cause spinal problems in fighter pilots, but the amount of tolerable cumulative +G_z exposure or its intensity is not known. The aims of this study were to assess possible breaking points during a flight career and to evaluate possible determinants affecting pilots' spines.METHODS: Survival analysis was performed on the population who started their jet training in 1995-2015. The endpoint was permanent flight duty restriction due to spinal disorder. Then the quantified G_z exposure and possible confounding factors were compared between those pilots with permanent flying restriction and their matched controls. Cumulative G_z exposure was measured sortie by sortie with fatigue index (FI) recordings. FI is determined by the number of times certain levels of G_z are exceeded during the sorties.RESULTS: The linear trend of the survival curve indicates an annual 0.86% drop out rate due to spinal problems among the fighter pilot population. A conditional logistic regression did not find any difference in the FI between cases and controls (OR 0.96, 95%CI 0.87-1.06). No statistical difference was found for flight hours, a sum of intensive flying periods, fitness tests, or with nicotine product use. Additionally, a maximum +G_z limitation without airframe restriction was assessed and is presented as a useful tool to manage loading and developed symptoms.DISCUSSION: No particular breaking point during follow-up or individual factor was found for G_z induced spinal disorders. The results of the study outline the multifactorial nature of the problem. Thus, multifactorial countermeasures are also needed to protect pilots' health.Sovelius R, Honkanen T, Janhunen M, Mäntylä M, Huhtala H, Leino T. +Gz exposure and flight duty limitations. Aerosp Med Hum Perform. 2022; 93(4):390-395.

Longitudinal study of medical downgrades in the Royal Air Force

INTRODUCTION

As the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement.

METHOD

Database of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region.

RESULTS

2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among 'high risk' personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged.

CONCLUSION

Musculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.

Kettlebell training in clinical practice: a scoping review

BACKGROUND

A scoping review of scientific literature on the effects of kettlebell training. There are no authoritative guidelines or recommendations for using kettlebells within a primary care setting. Our review objectives were to identify the extent, range and nature of the available evidence, to report on the types of evidence currently available to inform clinical practice, to synthesise key concepts, and identify gaps in the research knowledge base.

METHODS

Following the PRISMA-ScR Checklist, we conducted a search of 10 electronic databases from inception to 1 February 2019. There were no exclusions in searching for publications. A single reviewer screened the literature and abstracted data from relevant publications. Articles were grouped and charted by concepts and themes relevant to primary care, and narratively synthesised. Effect sizes from longitudinal studies were identified or calculated, and randomised controlled trials assessed for methodological quality.

RESULTS

Eight hundred and twenty-nine records were identified to 1 February 2019. Four hundred and ninety-six were screened and 170 assessed for eligibility. Ninety-nine publications met the inclusion criteria. Effect sizes were typically trivial to small. One trial used a pragmatic hardstyle training program among healthy college-age participants. Two trials reported the effects of kettlebell training in clinical conditions. Thirty-three studies explicitly used 'hardstyle' techniques and 4 investigated kettlebell sport. Also included were 6 reviews, 22 clinical/expert opinions and 3 case reports of injury. Two reviewers independently evaluated studies using a modified Downs & Black checklist.

CONCLUSIONS

A small number of longitudinal studies, which are largely underpowered and of low methodological quality, provide the evidence-informed therapist with little guidance to inform the therapeutic prescription of kettlebells within primary care. Confidence in reported effects is low to very low. The strength of recommendation for kettlebell training improving measures of physical function is weak, based on the current body of literature. Further research on reported effects is warranted, with inclusion of clinical populations and investigations of musculoskeletal conditions common to primary care. There is a need for an externally valid, standardised approach to the training and testing of kettlebell interventions, which better informs the therapeutic use of kettlebells in primary care.