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Cited by 15Mindfulness and Compassion InterventionsSport Psychology and PerformanceMusculoskeletal pain and rehabilitation

Effectiveness of Acceptance and Commitment Therapy in Increasing Resilience and Reducing Attrition of Injured US Navy Recruits.

Open access
Udell, Christopher J, Ruddy, Julie L, Procento, Philip M·2018·Military Medicine
DOI 10.1093/milmed/usx109
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Abstract

Introduction: US Navy recruits who have injuries preventing them from participating in intense physical conditioning are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications, and psychoeducational groups. Graduation from boot camp for these recruits requires not only recovering from their injuries but also passing a required Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups, and push-ups. About 50-60% of these recruits will eventually be separated out and sent home. The purpose of this study is to examine the effectiveness of an Acceptance and Commitment Therapy (ACT)-based program called Mindfulness for Pain and Performance Enhancement (MPPE). This treatment program was designed to help recruits effectively handle pain and assist them in improving their physical performance in the service of recovery, boot camp completion, and entrance into the Navy.Materials and Methods: This study was approved by the Edward Hines VA Hospital/Captain James A. Lovell Federal Health Care Center Institutional Review Board and the Naval Services Training Command. Treatment was voluntary and a total of 373 recruits enrolled in one of the 32 cycles of MPPE administered. Attrition was 35.1% (131 recruits). The control group comprised 310 recruits who did not enroll in MPPE. Recruits continued to receive standard treatment services (e.g., physical therapy, medical interventions, and psychoeducational groups) while participating in MPPE. Chi-square tests and one-way analysis of variance were used to analyze comparisons among treatment, control, and attrition groups on demographic, clinical, and boot camp training variables. Paired sample t-tests and Cohen's d effect sizes were computed to assess change on treatment outcome measures. Logistic regression was performed to identify demographic, clinical, and boot camp training variables predictive of graduation.Results: All of the pre- to post-treatment outcome measures were significant and Cohen's d effect sizes ranged from 0.41 to 0.84. Effect size changes were small for anxiety and experiential avoidance; moderate for pain acceptance, mindfulness, cognitive inflexibility, and depression; and large for pain reduction. Treatment completers graduated at a higher rate (58.3%) than attrites (34.4%) or controls (45.5%). Based on a logistic regression model, variables predictive of graduation included MPPE completion, age, and reported pain rating.Conclusion: MPPE is a six-session, 2-wk-long Acceptance and Commitment Therapy-based approach to pain and physical performance that was added to existing treatment services. Results supported the use of this program for helping recruits recover from injuries and successfully pass physical training requirements for graduation. Recruits were not randomly assigned to treatment, thus limiting the interpretation of outcomes. Incorporating this treatment earlier in boot camp training and making it available to more recruits (i.e., not only injured recruits) may further reduce attrition and contribute to greater resiliency of sailors within the US Navy fleet.

Integrity signals

Registry

Crossref · 10.1093/milmed/usx109

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

4 of 18 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Much of the attrition (65.6%) came from recruits who voluntarily stopped attending after the second session.

    “much of this attrition (65.6%) came from recruits who voluntarily stopped attending after the second session.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Age made a unique statistically significant contribution to the logistic regression model (p<0.01; OR 1.07; 95% CI 1.02-1.13).

    “age (p < 0.01; OR 1.07; 95% CI 1.02-1.13)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Pre-to post-treatment effect size for pain acceptance was d=0.64 (95% CI 0.51-0.78).

    “Pre-to post-effect sizes with 95% CI were as follows: pain (d = 0.84, CI = 0.66-0.95),pain acceptance (d = 0.64, CI = 0.51-0.78),mindfulness (d = 0.60, CI = 0.47-0.74),cognitive fusion (d = 0.63, CI = 0.48-0.76),experiential avoidance (d = 0.48, CI = 0.34-0.61),depression (d = 0.54, CI = 0.39-0.66),and anxiety (d = 0.41, CI = 0.27-0.54).”
    Quote in the paperSubstantial claim
  • Findingown data

    MPPE completion compared with not participating at all made a unique statistically significant contribution to the logistic regression model (p<0.001; OR 1.95; 95% CI 1.28-2.98).

    “or not participating at all (p < 0.001; OR 1.95; 95% CI 1.28-2.98)”
    Quote in the paperSubstantial claim
  • Findingown data

    Excluding separation classifications with low cell counts, there was no significant association between group (treatment, control, or attrite) and reason for separation (χ2(8, n=309)=10.16, p>0.05).

    “Excluding separation classifications that had low cell counts, there was not a significant association between group (treatment, control, or attrite) and reason for separation, χ 2 (8, n = 309) = 10.16,p > 0.05.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 27

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Acceptance and Action Questionnaire-2 in the present sample was excellent (α = 0.91).

    “Internal consistency in the present sample was excellent (α = 0.91).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] Bond, 2011, Preliminary psychometric properties of the acceptance and action questionnaire – II: a revised measure of psychological flexibility and acceptance, Behav Ther source

      The Abstract (page unavailable) reports satisfactory AAQ-II reliability, with a mean alpha of .84 across the source paper’s samples. It does not establish α = .91 for the citing authors’ present sample; that sample-specific result must come from their own data. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Cognitive Fusion Questionnaire in the present sample was excellent (α = 0.92).

    “Internal consistency in the present sample was excellent (α = 0.92).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] Gillanders, 2014, The development and initial validation of the cognitive fusion questionnaire, Behav Ther source

      The CFQ Psychometric Summary reports a Cronbach’s α of .92 for one of the source paper’s samples, and the text accompanying Table 5 describes the CFQ’s internal reliability across its samples as excellent. These passages do not establish internal consistency in the citing paper’s “present sample.” (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    ACT for chronic pain is empirically supported by randomized controlled trials, partially controlled trials, and effectiveness studies.

    “ACT for chronic pain is empirically supported by randomized control trials, [2][3][4][5][6][7] partially controlled trials, 8,9 and effectiveness studies, [10][11][12][13][14][15]”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [2][3][4][5][6][7]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Johnston, 2010, The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain, Clin J Pain source
    • cites [9] Vowles, 2009, Targeting acceptance, mindfulness, and values- based action in chronic pain: findings of two preliminary trials of an outpatient group-based intervention, Cogn Behav Pract source
    • cites [10][11][12][13][14][15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Patient Health Questionnaire-9 in the present sample was good (α = 0.84).

    “Internal consistency in the present sample was good (α = 0.84).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [37] Kroenke, 2001, The PHQ-9: validity of a brief depression severity measure, J Gen Intern Med source

      The Results (Reliability and Efficiency of the PHQ-9) support good internal consistency, reporting Cronbach’s α values of 0.89 and 0.86 in the paper’s two samples. They do not support α = 0.84 for the citing study’s present sample; the paper’s 0.84 is a test–retest correlation, not Cronbach’s α. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Attendance in psychoeducation groups and length of time spent in the RCU were not predictive of graduation.

    “Attendance in psychoeducation groups and length of time spent in the RCU were not predictive of graduation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Compared with recruits who were later separated, recruits who later graduated reported greater improvement on pain, mindfulness, depression, and anxiety.

    “Compared with recruits who were later separated, recruits who later graduated reported greater improvement on pain, mindfulness, depression, and anxiety; less improvement on pain acceptance and cognitive fusion; and equivalent improvement on experiential avoidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All pre-to post-treatment outcome measures produced significant effects, with Cohen's d effect sizes ranging from 0.41 to 0.84.

    “All of the pre-to post-treatment outcome measures were significant and Cohen's d effect sizes ranged from 0.41 to 0.84.”
    • Also stated in: § Pre-treatment Differences and Pre-to Posttreatment Changes · plain
      “All treatment measures produced significant effects (see Table III).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The logistic regression model accounted for 31% of the variance in graduation rates and correctly classified 71.5% of cases.

    “This model accounted for 31% of the variance in graduation rates [χ 2 (12) = 179.13,p < 0.001, Nagelkerke R 2 = 0.31] and correctly classified 71.5% of cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Treatment completers were significantly more likely to attend psychoeducational groups, but completers who later graduated attended fewer (6.3) sessions than completers who were later separated (7.5).

    “Treatment completers were significantly more likely to attend these groups, but completers who later graduated attended fewer (6.3) sessions than completers who were later separated (7.5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Treatment produced significant improvements on all outcome measures.

    “Treatment was only 2 wk long, yet produced significant improvements on all outcome measures, with effect sizes of large for pain reduction, medium for pain acceptance, mindfulness, cognitive inflexibility, and depression and small for experiential avoidance and anxiety.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Psychoeducational group participation was not significantly associated with graduation, but recruits who attended two or fewer groups were more likely to graduate than those who attended more than two.

    “Psychoeducational group participation was not significantly associated with graduation, but recruits who attended two or fewer groups were more likely to graduate than those who attended more than two.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common reason for separation was MTLJ injuries (26.1%), followed by skeletal injuries (22.8%), pain (21.1%), and mental disorders (primarily adjustment disorders; 14.3%).

    “The most common reason for separation was MTLJ injuries (26.1%), followed by skeletal injuries (22.8%), pain (21.1%), and mental disorders (primarily adjustment disorders; 14.3%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences among treatment completers, attrites, and controls on the injuries and conditions that put them in the RCU, except for skeletal injuries that were more frequent for completers.

    “There were no significant differences among treatment completers, attrites, and controls on the injuries and conditions that put them in RCU, except for skeletal injuries that were more frequent for completers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were 327 (47.8%) recruits who graduated and 356 (52.2%) who separated.

    “There were 327 (47.8%) recruits graduated and 356 (52.2%) separated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There were no significant differences in booster session attendance.

    “Moreover, there were no significant differences in booster session attendance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both males and females in the treatment group graduated at higher rates compared with attrites and controls.

    “However, both males (63.8%) and females (50.5%) in the treatment group graduated at higher rates compared with attrites (males: 38.0%; females: 30.9%) and controls (males: 50.0%; females: 41.6%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Males and recruits over age 20 years were significantly more likely to graduate.

    “Males and recruits over age 20 yr were significantly more likely to graduate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There were significantly more males than females among treatment completers compared with attrites and controls.

    “There were significantly more males than females among treatment completers compared with attrites and controls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The effect sizes for pain acceptance, mindfulness, cognitive inflexibility, and depression were medium.

    “medium for pain acceptance, mindfulness, cognitive inflexibility, and depression”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    Recruits commonly entered MPPE within 1-4 weeks of their injuries.

    “recruits commonly entered MPPE within 1-4 wk of their injuries.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a significant relationship between graduation and condition/injury at transfer to the RCU, with MTLJ injuries most associated with separation.

    “There was a significant relationship between graduation and condition/injury at transfer to the RCU, with MTLJ injuries most associated with separation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The effect sizes for experiential avoidance and anxiety were small.

    “small for experiential avoidance and anxiety”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The experience of brief pain in a laboratory setting differs in many ways from pain that arises in the aftermath of a stress fracture or dislocated limb.

    “However, the experience of brief pain in a laboratory setting differs in many ways from pain that arises in the aftermath of a stress fracture or dislocated limb.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Pain Rating System in the present sample was good (α = 0.83).

    “Internal consistency in the present sample was good (α = 0.83).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Otis, 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Chronic Pain Acceptance Questionnaire-8 in the present sample was acceptable (α = 0.76).

    “Internal consistency in the present sample was acceptable (α = 0.76).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Fish, 2010, Validation of the chronic pain acceptance questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8, Pain source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The pressure of completing physical training requirements elevates recruits' tendency to over-evaluate and attempt to avoid, reduce, or eliminate emotional and physical discomfort.

    “The pressure of completing physical training requirements in order to graduate elevates the tendency to over-evaluate and attempt to avoid, reduce, or eliminate emotional and physical discomfort.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sports psychology has seen an increase in empirically supported mindfulness and acceptance approaches to enhancing athletic performance.

    “Sports psychology has seen an increase in empirically supported mindfulness and acceptance approaches to enhancing athletic performance.[23][24][25][26][27][28][29][30][31]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23][24][25][26][27][28][29][30][31]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Cognitive and Affective Mindfulness Scale-Revised in the present sample was good (α = 0.85).

    “Internal consistency in the present sample was good (α = 0.85).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Feldman, 2007, Mindfulness and emotion regulation: the development and initial validation of the cognitive and affective mindfulness scale-revised (CMS-R), J Psychopathol Behav Assess source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This study was approved by the Edward Hines VA Hospital/Captain James A. Lovell Federal Health Care Center Institutional Review Board and the Naval Services Training Command.

    “This study was approved by the Edward Hines VA Hospital/ Captain James A. Lovell Federal Health Care Center Institutional Review Board and the Naval Services Training Command.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    As recruits become preoccupied with negative thoughts and unwanted sensations, they are at greater risk to engage in behaviors that diminish physical performance.

    “As recruits become preoccupied with negative thoughts and unwanted sensations, they are at greater risk to engage in behaviors that diminish physical performance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Observing and allowing uncomfortable internal experiences, flexibly shifting attention into the present moment, and taking value consistent action may improve physical performance.

    “In contrast, observing and allowing uncomfortable internal experiences, flexibly shifting attention into the present moment, and taking value consistent action (e.g., engaging in physical training) may improve physical performance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Significant main effects were found for length of time in RCU and number of psychoeducational groups attended.

    “Significant main effects were found for length of time in RCU [F(2, 680) = 22.62, p < 0.001] and number of psychoeducational groups attended [Welch's F(2, 300.40) = 46.25,p < 0.001].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Results supported the use of MPPE for helping recruits recover from injuries and successfully pass physical training requirements for graduation.

    “Results supported the use of this program for helping recruits recover from injuries and successfully pass physical training requirements for graduation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Recruits could enter MPPE any time while in the RCU, so the lowest and highest pain ratings they reported during medical appointments could have been before, during, or after their participation in MPPE.

    “Recruits could enter MPPE any time while in the RCU, so the lowest and highest pain ratings they reported during medical appointments could have been before, during, or after their participation in MPPE.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Pain ratings collected on medical visits were limited to physical pain, whereas the PRS used in MPPE includes items on emotional pain associated with physical pain.

    “Also, whereas pain ratings collected on medical visits were limited to physical pain, the PRS used in MPPE includes items on emotional pain associated with physical pain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Recruits who dropped out may have been distinctly different from the recruits who stayed on unknown factors predictive of graduation.

    “But those recruits who dropped out may have been distinctly different from the recruits who stayed on unknown factors predictive of graduation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was a higher percentage of males in the treatment group (58.3%) than in attrition (48.1%) or control (46.5%) groups, χ2(2, n=683)=8.12, p<0.02.

    “However, there was a higher percentage of males in the treatment group (58.3%) than in attrition (48.1%) or control (46.5%) groups, χ 2 (2, n = 683) = 8.12, p < 0.02.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Treatment completers were in the RCU significantly longer and attended significantly more psychoeducational groups than attrites and controls.

    “Treatment completers were in the RCU significantly longer and attended significantly more psychoeducational groups than attrites and controls.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    There could be particular characteristics about recruits who chose to participate in treatment that might limit the conclusions drawn.

    “There could be particular characteristics about those recruits who chose to participate in treatment that might limit the conclusions drawn.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the Generalized Anxiety Disorder Seven-Item in the present sample was good (α = 0.89).

    “Internal consistency in the present sample was good (α = 0.89).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Spitzer, 2006, A brief measure for assessing generalized anxiety disorder, Arch Intern Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    There were no significant differences among groups on age and race.

    “There were no significant differences among groups on age and race.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The treatment sample in this study differed from participants in ACT for chronic pain trials on age (average 21 years), motivation, and the absence or reduced incidence of disqualifying medical and mental health conditions.

    “The treatment sample in this study also differed from participants in ACT for chronic pain trials on factors such as age (i.e., average age in the current study was 21 yr), motivation (e.g., receiving treatment that could help them graduate), and the absence or reduced incidence of disqualifying medical and mental health conditions.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Participants in ACT for chronic pain studies report duration of pain generally ranging from 1 10 to 15 5 years.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Recruits who entered treatment may have already had higher pain tolerance, greater resiliency, or stronger motivation to pass the PFA and graduate.

    “Recruits who entered treatment may have already had higher pain tolerance, greater resiliency, or stronger motivation to pass the PFA and graduate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    There were no significant differences among groups on week of training at time of transfer to RCU, transfer from FIT, or pain ratings.

    “There were no significant differences among groups on week of training at time of transfer to RCU, transfer from FIT, or pain ratings (i.e., pain rated on a scale of 0-10; see Table I).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Recruits were not randomly assigned to treatment, limiting the interpretation of outcomes.

    “Recruits were not randomly assigned to treatment, thus limiting the interpretation of outcomes.”
    Quote in the paperSubstantial claim
45 of 45

  • The paper relies on this without support.

    About 50-60% of injured recruits who are pulled from training will eventually be separated and sent home.

    “About 50-60% of these recruits will eventually be separated out and sent home.”
    “The length of time on hold from training can range from a week to a few months; 50-60% are ultimately separated (i.e., sent home.)”

  • The paper relies on this without support.

    There are no published treatment studies on ACT for acute pain (lasting 2-6 wk) or subacute pain (lasting 7-12 wk).

    “but there are no published treatment studies on acute pain (e.g., lasting 2-6 wk) or subacute pain (e.g., lasting 7-12 wk).”

  • The paper relies on this without support.

    There are no published studies on psychological treatment for pain or performance enhancement in Navy recruits.

    “There are no published studies on psychological treatment for pain or performance enhancement in Navy recruits.”

  • The paper relies on this without support.

    US Navy recruits undergoing rigorous physical training are at risk of becoming overwhelmed by negative thoughts, emotions, and bodily states.

    “US Navy recruits undergoing rigorous physical training are at a risk of becoming overwhelmed by negative thoughts, emotions, and bodily states.”

  • The paper relies on this without support.

    There are no published studies on mindfulness and acceptance-based treatment for people in the acute or subacute phases of pain following an injury.

    “The current study was unique in that there are no published studies on mindfulness and acceptance-based treatment for people in the acute or subacute phases of pain following an injury.”

  • The paper relies on this without support.

    Many recruits come to boot camp in unsatisfactory physical shape.

    “Many recruits come to boot camp in unsatisfactory physical shape.”

  • The paper relies on this without support.

    Injuries may not be discovered until recruits are in FIT.

    “Unfortunately, injuries may not be discovered until recruits are in FIT.”

  • The paper relies on this without support.

    The current study represents the first time that a behavioral intervention was implemented to assist these recruits and reduce attrition.

    “The current study represents the first time that a behavioral intervention was implemented to assist these recruits and reduce attrition.”

  • The paper relies on this without support.

    Participants in ACT for chronic pain studies report duration of pain generally ranging from 1 10 to 15 5 years.

    “Although participants in ACT for chronic pain studies report duration of pain generally ranging from 1 10 to 15 5 years, recruits commonly entered MPPE within 1-4 wk of their injuries.”
9 of 9

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(2, 680) = 22.62reported p < .001 · recomputed p < .001

    “F(2, 680) = 22.62, p < .001”

  • ConsistentF(2, 300.4) = 46.25reported p < .001 · recomputed p < .001

    “F(2, 300.40) = 46.25,p < .001”

  • Consistentt(371) = 2.2reported p < .05 · recomputed p = .028

    “t (371) = 2.20, p < .05”

  • Consistentt(231.9) = 2.07reported p < .05 · recomputed p = .040

    “t (231.9)= 2.07, p < .05”

  • Consistentt(231) = 1.19reported p > .05 · recomputed p = .235

    “t (231) = 1.19, p > .05”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Attrite MTLJ subcategory percentage is overstated

    Minor

    In Table II, seven of 131 attrites is 5.3%, not the 5.5% shown for the MTLJ "Other" category.

    Reported 5.5 · recomputed 5.343511

  • Shin-splint separation percentage does not match its count

    Minor

    Table IV lists 101 separations in the treatment group. Nine of 101 is 8.9%, not 7.9%.

    Reported 7.9 · recomputed 8.910891

  • Attrite MTLJ percentage does not match its count

    Minor

    Table II gives 131 attrites and 46 with MTLJ conditions. That is 35.1%, rather than 34.4%.

    Reported 34.4 · recomputed 35.114504

  • Medical-clearance percentage uses the wrong denominator

    Minor

    The text identifies 131 attrites. Eighteen of 131 is 13.7%, not 14.6%.

    Reported 14.6 · recomputed 13.740458

4 of 4

Cites

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2 of the 47 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Udell, C. J., Ruddy, J. L., & Procento, P. M.
Affiliations
Captain James A. Lovell Federal Health Care Center (US)
Venue
Military Medicine
Publisher
Oxford University Press (OUP)
Published
2018-03-06
Volume
183
Issue
9-10
Pages
e603-e611
ISSN
  • 0026-4075 (ISSN-L)
  • 1930-613X
DOI
10.1093/milmed/usx109
OpenAlex
W2789762412
Cited by
15
References
47
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 1
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Military Medicine (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • U.S. Department of Defense
  • U.S. Navy
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
acceptance and commitment therapy, military recruits, injury recovery, pain acceptance, mindfulness, physical performance, resilience, experiential avoidance, cognitive inflexibility, naval recruits, pain management, anxiety, depression, predictors of treatment dropout, predictors of treatment completion, predictors of treatment response
MeSH terms
Adolescent, Female, Humans, Male, Military Personnel, Psychometrics, Surveys and Questionnaires, Teaching, Chi-Square Distribution, Logistic Models, Resilience, Psychological, Young Adult, Acceptance and Commitment Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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