title: Vehicle Exposure and Spinal Musculature Fatigue in Military Warfighters: A Meta-Analysis.
abstract: BACKGROUND
  Spinal musculature fatigue from vehicle exposure may place warfighters at risk for spinal injuries and pain. Research on the relationship between vehicle exposure and spinal musculature fatigue is conflicting. A better understanding of the effect of military duty on musculoskeletal function is needed before sports medicine teams can develop injury-prevention programs.
  
  
  OBJECTIVE
  To determine if the literature supports a definite effect of vehicle exposure on spinal musculature fatigue.
  
  
  METHODS
  We searched the MEDLINE, Military & Government Collection (EBSCO), National Institute for Occupational Safety and Health Technical Information Center, PubMed, and Web of Science databases for articles published between January 1990 and September 2015.
  
  
  METHODS
  To be included, a study required a clear sampling method, preexposure and postexposure assessments of fatigue, a defined objective measurement of fatigue, a defined exposure time, and a study goal of exposing participants to forces related to vehicle exposure.
  
  
  METHODS
  Sample size, mean preexposure and postexposure measures of fatigue, vehicle type, and exposure time.
  
  
  RESULTS
  Six studies met the inclusion criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for quality appraisal of each article. Unweighted random-effects model meta-analyses were conducted, and a natural log response ratio was used as the effect metric. The overall meta-analysis demonstrated that vehicle exposure increased fatigue of the spinal musculature (P = .03; natural log response ratio = -0.22, 95% confidence interval = -0.42, -0.02). Using the spinal region as a moderator, we observed that vehicle ride exposure significantly increased fatigue at the lumbar musculature (P = .02; natural log response ratio = -0.27, 95% confidence interval = -0.50, -0.04) but not at the cervical or thoracic region.
  
  
  CONCLUSIONS
  Vehicle exposure increased fatigue at the lumbar region.
authors.affiliation: Department of Kinesiology and Rehabilitative Sciences, The University of Tulsa, OK.
authors.forename: Roger O
authors.initials: RO
authors.lastname: Kollock
authors.affiliation: Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Games
authors.affiliation: School of Fisheries, Aquaculture, and Aquatic Sciences, Auburn University, AL.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Wilson
authors.affiliation: Warrior Research Center, School of Kinesiology, Auburn University, AL.
authors.forename: JoEllen M
authors.initials: JM
authors.lastname: Sefton
mesh_terms: D005221:Fatigue / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008889:Military Personnel; D013124:Spinal Injuries / Q000150:complications*
keywords: acceleration; g forces; mechanical shock; soldiers; vibration