USU-Led Global Initiative Standardizes Injury Research, Boosts Readiness

The ROMMIL framework unifies musculoskeletal injury reporting across nations to improve data quality and force lethality.

December 17, 2025 submitted by MIRROR

Musculoskeletal injuries remain the leading cause of medical encounters and lost duty time across armed forces worldwide. In the U.S. Army alone, these injuries account for more than 22 million limited-duty days annually.

Despite decades of study, progress in preventing these injuries has been limited by one fundamental obstacle: a lack of standardization. Different definitions and inconsistent reporting practices have made it nearly impossible to compare findings across studies or military services.

To overcome this barrier, a team led by researchers from the Uniformed Services University (USU) has established a new global standard.

After several years of international collaboration, Dr. Daniel Rhon, a professor at USU's F. Edward Hebert School of Medicine, spearheaded the "Reporting of Musculoskeletal Injuries in the Military" (ROMMIL) initiative. This effort brought together more than 100 experts from the U.S., U.K., Canada, Australia, New Zealand, Belgium, and other allied nations to unify how injuries are studied and reported.

The project, supported in part by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) program at USU, culminated in 2025 with a major publication in the Medicine & Science in Sports & Exercise journal.

This new framework addresses the variability that has long hindered progress by establishing a "Common Data Element" checklist. The checklist defines 33 minimum data elements that should be collected in all future research, ensuring consistency across the globe. These elements are grouped into five key domains:

• Demographics: Standardizing basics such as age, sex, height, weight, rank, branch, and role.
• Lifestyle & Exposure: Tracking factors like tobacco use, training environment, and workload.
• Medical & Injury History: Recording prior musculoskeletal injuries and orthopedic surgeries.
• Injury Characteristics: Defining the mechanism of injury, body region, diagnosis, and time to care.
• Operational Impact: Measuring lost duty time, recovery course, and functional outcomes.

A guiding principle of the framework is to "keep continuous data continuous". By reporting actual values-such as a soldier's exact age or body mass index-rather than broad categorical groupings, researchers can significantly improve analytic precision and comparability.

Developing this rigorous standard required a transparent, 10-step consensus process. The ROMMIL team combined scoping reviews, surveys of 91 stakeholders across all military branches, and three rounds of voting. The process concluded with a final consensus meeting at the 2023 International Congress on Soldiers' Physical Performance in London, ensuring the recommendations were both scientifically sound and operationally practical.

The adoption of the ROMMIL standards establishes the first truly international standard for surveillance in military settings. By ensuring data is comparable across studies and nations, the initiative enables large-scale meta-analyses and predictive modeling that were previously impossible. This enhanced data quality bridges the gap between research and operational readiness, ensuring data directly informs policy and resource allocation.

Ultimately, the initiative aims to support force readiness and generate cost savings by reducing the injury burden. However, the team notes that publication is only the beginning. Success now depends on broad adoption by researchers, funders, and leaders embedding these standards into operational practice.

"If we can all just agree to improve a little the 'how' and 'what' we are reporting, to ensure we're all speaking the same language," says Rhon, "it will increase exponentially the impact of the work we're already doing."

As the initiative moves forward, it provides the global military community with the means to measure injury accurately and consistently, laying the foundation for a stronger, healthier, and more ready force.