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Open research questions in Occupational Health and Performance

50 unresolved questions extracted from the limitations and future-work sections of 514 Occupational Health and Performance papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Exposures to carrying, climbing stairs, kneeling and squatting during the IOC were insufficient to reach any of the RMA-specified thresholds for the development or clinical worsening of lower limb OA.

    EXPOSURE TO RISK FACTORS FOR DEVELOPMENT OF LOWER LIMB OSTEOARTHRITIS DURING AIR FORCE INITIAL OFFICER TRAINING · 2026 · DOI

  • The burden of OA in military occupations, such as air force officers, is not limited to the cost of training, which can be over one million US dollars per pilot, for example, but extends to deficits in combat readiness and capabilities.

    EXPOSURE TO RISK FACTORS FOR DEVELOPMENT OF LOWER LIMB OSTEOARTHRITIS DURING AIR FORCE INITIAL OFFICER TRAINING · 2026 · DOI

  • An important limitation of the present study concerns the interpretation of PTSD risk based on the Mississippi Scale for Combat-Related PTSD. Although this instrument demonstrates high reliability and is widely used for screening purposes, the cut-off values applied in this study should be regarded as non-clinical and non-validated for diagnostic decision-making. The classification of PTSD risk levels was used exclusively as a screening and risk stratification tool and should not be interpreted as a clinical diagnosis. The identified risk categories reflect the probability of elevated post-traumatic stress symptoms rather than confirmed PTSD. Final diagnosis, clinical confirmation, and treatment planning require comprehensive assessment by qualified mental health professionals, including psychologists or psychiatrists. Accordingly, the proposed predictive model is intended to support early identification and preventive interventions rather than replace professional clinical evaluation. Another limitation relates to the use of self-report survey methods for data collection. While this approach is appropriate given the specific conditions of military service, including training activities, combat missions, and rehabilitation periods, self-assessment may be subject to response bias and reporting inaccuracies. Therefore, the findings should be interpreted with caution, and future studies should incorporate objective psychophysiological and clinical measures to strengthen validity. Finally, the study sample included a substantially smaller proportion of female military personnel compared to males. Given the observed gender differences in PTSD risk prevalence and contributing factors, the development and validation of predictive models for female military personnel require further investigation based on larger and more representative samples.

    Applicating Multivariate Adaptive Regression Splines (MARSplines) for Predicting Post-Traumatic Stress Disorder Risk in Military Personnel · 2026 · DOI

  • A limitation of this study was potential for recall bias. As some questions in the survey covered the entire service life of the PTGs, recall bias may have been present and responses to questions about occupational tasks may not have been accurately recalled. To mitigate this risk, questions were, where possible, designed to focus on the most recent experiences of respondents. In many other contexts, the all-male sample would be of a concern, however, in the PTG context it was to be expected, as all personnel in the PTGs at the time of testing were male. While this study represents an initial step in understanding more about physical training in these specialist police groups and the injuries they suffer, future research should profile the injuries in greater detail to better inform injury reduction programs.

    Investigating training as a source of injury with specialist tactical law enforcement personnel · 2026 · DOI

  • This study was co-designed and delivered via a collabora- tion between consumer, industry and research advisory groups, reducing the inherent biases from any one group [17, 20]. Further, through promoting diversity in par- ticipant inclusion [22], and application of the closeness Murphy et al. Sports Medicine - Open (2026) 12:81 Page 12 of 21 continuum for healthcare providers and research experts, bias was limited. Police force staff and recruits were from a single police force jurisdiction, which from an imple- mentation lens is a study strength, but may limit the gen- eralisability of the results. The number of participants in our police recruit/officer group (n = 6) may appear small. However, > 10 of the police force staff group members were also police force officers so the number of partici- pants who had lived experience of the recruit training program was > 15, representing the largest proportion of participants. All participants volunteered and this may introduce selection bias. Ratings were summarised using mean scores, as per established practice, but may not fully capture variability of responses. The results of Welch’s t-test should be interpreted cautiously. As such, we opted to analyse our sample into two groups (police force vs healthcare providers and research experts) as opposed to the four participant groups. Further, we dis- cussed differences in the ‘order’ of the clusters between groups and did not just rely on the between-group statis- tical value.

    Co-Creating an Intervention to Prevent Injuries in Police Force Recruits: A Concept Mapping Study of Police Force Recruits, Police Force Staff, Health Professionals, and Research Experts · 2026 · DOI

  • Our co-creation is guided by the Translating Research into Injury Prevention Practice (TRIPP) framework [41]. Previous research has established the epidemiology (step one) [4, 6], and aetiology (step two) [8]. Our mixed- method concept mapping approach has contributed to intervention development (step three). However, it is important to note that this is just one step in our inter- vention co-creation [14], with co-creation also guided by systematic reviews and further qualitative research [20]. We identified strategies to consider when develop- ing an injury prevention intervention for police force recruits. However, concept mapping relies on partici- pants’ perceptions of importance and feasibility, which may be influenced by individual roles and experiences rather than objective effectiveness. Therefore, our results must be considered alongside data relating to the effec- tiveness of the strategies proposed (as per previous clini- cal research), and a more detailed exploration of the contextual factors. This will enable to co-creation of a prevention intervention, in alignment with our estab- lished how-to-guide [14]. Systematic reviews and meta-analyses of the efficacy of all prevention interventions in recruit populations are needed. However, due to the dearth of literature in law enforcement recruit injury prevention, findings from comparable populations (e.g., military recruits or com- munity sports) may be extrapolated to guide selection of effective strategies. To gain a deeper understanding of the contextual factors in a specific environment (e.g., a single police recruit jurisdiction) qualitative research involving police force staff and recruits is needed. This qualitative approach will explore what the prevention intervention will consist of by providing a better understanding of what prevention strategies are already in place, and how other strategies could be implemented. Subsequently driving the next stage of co-creation. Thus, our concept mapping approach, as well as further reviews of the lit- erature and qualitative research should inform the devel- opment of a potentially effective prevention intervention, which can then be implemented and tested.

    Co-Creating an Intervention to Prevent Injuries in Police Force Recruits: A Concept Mapping Study of Police Force Recruits, Police Force Staff, Health Professionals, and Research Experts · 2026 · DOI

  • Keywords: CBT-I Sleep quality Shift work Growth mixture model Multinomial logistic regression Mathematical model Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-established treatment for chronic insomnia, but its effectiveness varies widely, particularly among shift workers who face irregular sleep-wake schedules and elevated stress levels.

    Individual and occupational predictors of CBT-I response patterns among shift-working firefighters · 2026 · DOI

  • Nevertheless, the main limitation of the study is the wide variation in research methods observed for each motor ability. in addition is the relatively small number of studies devoted to abilities such as balance and flexibility, which may be important in operational activities. The results of the review also indicate that the research methodology should be standardized so that motor profiles can be compared between different special forces units and even between other populations. This may be necessary to better understand what kind of motor profile operators of special forces units are mainly characterized by. In addition, the creation of a motor profile and a single battery of tests can assist in the process of selection, training, and accelerate the return of operators to full fitness after injury. The systematic review conducted emphasizes the value of assessing motor skills in special forces operators. The study focuses exclusively on the motor profile of special forces operators, rather than the general military population. The article also provides important practical recommendations, emphasizing the need to standardize motor skills assessment methods in order to facilitate comparisons between units and the application of results in the selection, training, and rehabilitation of operators.

    Motor profile of male special forces operators: a systematic review · 2026 · DOI

  • This study has several strengths, including the concurrent load) and assessment of both mechanical (backpack behavioural (sitting time) factors associated with LBP in a previously under-researched population. The relatively large sample size and objective measurement of backpack and body mass further strengthen the robustness of the findings. However, certain limitations should be acknowledged. The cross-sectional design limits causal inference, and reliance on self-reported measures may introduce recall and reporting bias. In addition, sitting time data were available only for a subset of participants, which may limit the generalisability of findings on sedentary behaviour. Unmeasured factors such as psychosocial influences, physical fitness and growth-related changes may also contribute to LBP and were not accounted for in the present study. Although the YSQ and IPAQ-SF are validated instruments, no formal cultural adaptation or validation was conducted within the Botswana context, which may have influenced comprehension, response accuracy and the validity of self-reported data. Future research should consider longitudinal designs and objective measures of sedentary behaviour to better understand causal pathways.

    Associations between school backpack loading, sitting time and low back pain among schoolchildren in Gaborone, Botswana · 2026 · DOI

  • The heterogeneity of the included studies presents a challenge to coherently summarising the effects of IMT. As described, studies include IMT instances that span countries, timeframes and different measurement techniques, which render synthesis challenging. Specifically, the difference between service types, such as conscript versus volunteer populations, intro- duces significant variance in motivation and pre-enlistment conditioning. Furthermore, baseline fitness levels varied widely among cohorts, complicating the ability to isolate the specific impact of initial military training (IMT). This is exacerbated by the inability to control for variables known to influence performance, such as sleep deprivation, nutritional intake and psychological stress, which are common to the mil- itary environment. The training itself presented further incon- sistencies and lacked clarity, likely in part due to security risks with sharing a detailed training regimen. In many cases, mass training environments limit the feasibility of individualised training methodologies, and frequent shifts in training focus often occur throughout the course. In addition, the varying lengths of training courses and the specific requirements of different military branches (e.g. Army versus Air Force versus Navy) limit the generalisability of the results. Finally, the data may be affected by the nature of the assessments themselves; testing may not have been conducted maximally due to recruit fatigue or a lack of standardised motivation, potentially result- ing in underestimations of true neuromuscular capacity and obfuscation of true effects. Future research should prioritise the establishment of standardised physical assessment protocols across military cohorts, potentially leveraging more insightful measure- ment approaches and technologies. Large-scale, longitudinal studies with similar data collection methods are essential to improve comparability and to develop a more cohesive understanding of how specific training modalities influence long-term health and readiness. stages of the course. This plateau, likely driven by a lack of appropriate periodisation, increases injury risk and compro- mises safety. Research suggests that reducing endurance- based loads offers more favourable outcomes for strength and power. Consequently, tracking fatigue proxies is essen- tial to balance stressors with recovery, ultimately enhancing performance and reducing the high injury rates common in IMT [10, 26, 77]. It is important, however, to reiterate the significant heterogeneity observed across the included stud- ies, which makes a concise synthesis difficult and calls for more specific research. These physiological responses are further nuanced by sex-based differences in baseline conditioning and training strain. For instance, females typically enter IMT with lower initial fitness levels and consequently exhibit greater car- diovascular strain during load carriage. While both sexes show improvements in muscular endurance, these effects were more pronounced in females. Males maintain higher absolute isometric strength. However, the impact of cumula- tive fatigue also appears to diverge; limited data suggest that males may experience a greater reduction in jump power than females over the duration of IMT. These sex-specific variations highlight the importance of a degree of individu- alised monitoring to mitigate the high injury rates associated with the cumulative stress of training. Funding Open Access funding enabled and organized by CAUL and its Member Institutions. The authors declare they did not receive any funding or financial assistance for this manuscript.

    What Are the Acute and Chronic Effects of Initial Military Training on Physiological and Neuromuscular Performance in Military Populations? A Narrative Review · 2026 · DOI

  • The fire service generally quantifies the job demands of firefighting through tracking emergency call volume across 24 h shifts; however, volume alone does not account for the specific work completed in response to different call types.

    Workloads of Emergency Call Types in Active-Duty Firefighters · 2024 · DOI

  • Future research is needed on the fit and function of PPE for specialist police units, such as mounted police, along with further investigations on how fit can affect functional performance.

    The comfort and functional performance of personal protective equipment for police officers: a systematic scoping review · 2024 · DOI

  • Future research will focus on examining the association of BP emission ­exposure and objective sleep data extracted from polysomnography reports in the Veteran Affairs electronic medical records.

    0373 Association of U.S. Military Burn Pit Smoke Exposure with Insomnia and Sleep Apnea Symptoms · 2023 · DOI

  • The study had limited sample sizes for certain subgroups, with only 29 respondents completing sports medicine fellowship and gait retraining value questions, and 41 respondents with previous gait retraining training experience.

    Running Gait Retraining: A Sports Medicine Training Gap in Family Medicine · 2022 · DOI

  • Investigations are needed to develop simple and brief approaches to gait retraining that treat and prevent RRI to assist family physicians in practically incorporating gait retraining counseling in time- and resource-limited settings at the point of care.

    Running Gait Retraining: A Sports Medicine Training Gap in Family Medicine · 2022 · DOI

  • Gait retraining is not currently included in running-related injury (RRI) patient sports medicine curricula in family medicine training, representing a significant training gap.

    Running Gait Retraining: A Sports Medicine Training Gap in Family Medicine · 2022 · DOI

  • The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue.

    Overuse Injuries in the IDF’s Combat Training Units: Rates, Types, and Mechanisms of Injury · 2018 · DOI

  • Future research should examine if the instrumented BESS demonstrates validity against laboratory level force plates and if it is able to overcome the ceiling effect reported for the clinical BESS test.

    Reliability and concurrent validity of instrumented balance error scoring system using a portable force plate system · 2015 · DOI

  • On average, soldiers tended to slightly over-report performance on all APFT events and individual self-reported scores could vary widely from actual scores based on Bland-Altman plots.

    The Validity of Self-Reported Physical Fitness Test Scores · 2007 · DOI

  • Abstract Background Musculoskeletal conditions are a leading global cause of disability, yet the factors influencing long-term musculoskeletal health, particularly following trauma, remain incompletely understood.

    Novel Musculoskeletal Hypotheses in the Armed Services Trauma and Rehabilitation Outcome (ADVANCE) Cohort: Development and Application of Sparse Group Factor Analysis Methodology · 2026 · DOI

  • Wearing V2 and V3 produced mixed results, with V3 typically performing better than all other variations, including station wear.

    IMPACT OF VARIOUS CLOTHING VARIATIONS ON FIREFIGHTER MOBILITY: A PILOT STUDY · 2026 · DOI

  • · Future research should examine the effects of evidence based interventions aimed at reducing SPI amongst full-time and part-time soldiers.

    A DETAILED ANALYSIS OF SERIOUS PERSONAL INJURIES SUFFERED BY FULL TIME AND PART TIME SOLDIERS · 2026 · DOI

  • The following discussion explores each physical performance domain individually, then integrates these findings into practical implications for military readiness, and identifies gaps in the literature that warrant further investigation.

    A Systematic Review and Meta-Analysis on the Impact of Military Foot Marches on Performance—Part 1: Physical Performance · 2026 · DOI

  • The pattern of clinical presentation of SFs over time after individuals start a new or more demanding physical training regimen is not well defined in the medical literature.

    Timing of Stress Fractures in Soldiers During the First 6 Career Months: A Retrospective Cohort Study · 2021 · DOI

  • Although the data are limited, this study suggests that previous military pilots may differ slightly from other pilots in their subsequent civil aviation careers.

    PREVIOUS MILITARY PILOTS AND THEIR LATER FATAL CIVIL AVIATION ACCIDENTS · 2021 · DOI

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50 open questions have been extracted from the limitations and future-work passages of 514 Occupational Health and Performance papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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