Interdisciplinary Occupational Health System for Recovery From Musculoskeletal Injuries in US Army Personnel

Importance: Musculoskeletal injuries are a leading cause of pain, disability, and lost workforce productivity in the US. These injuries are more frequent in physically demanding occupations, making strategies to accelerate recovery a critical economic, public health, and workforce sustainability issue. Objective: To evaluate whether an embedded interdisciplinary occupational health intervention was associated with faster return-to-work times after a musculoskeletal injury. Design, Setting, and Participants: This cohort study analyzed longitudinal data on 43 870 526 person-month observations from active-duty US Army personnel collected between October 1, 2017, and September 30, 2025. Exposure: Assignment to an Army unit with an embedded Holistic Health and Fitness (H2F) occupational health system, which includes on-site physical therapists, athletic trainers, occupational therapists, registered dietitians, strength and conditioning coaches, and cognitive performance specialists. Main Outcomes and Measures: Number of limited duty workdays after a musculoskeletal injury and time to return to full duty. Linear regression, logistic regression, and Kaplan-Meier models with inverse probability of treatment weighting were used to estimate the association between the intervention and recovery outcomes. Results: Among 1 420 195 musculoskeletal injuries in active-duty soldiers (mean [SD] age, 28.6 [7.64] years; 79% male) that resulted in limited duty restrictions, 19% were in soldiers exposed to the H2F embedded occupational health system. Exposure to H2F was associated with a 5.9% (95% CI, 7.2%-4.6%; P < .001) reduction in the duration of limited duty workdays compared with soldiers not exposed to H2F. Reductions in limited duty workdays were greater for lower-body injuries than for upper-body injuries. These reductions corresponded to an estimated 3.3 million to 4.0 million workdays restored during the study period, representing an annual labor productivity value of $93 million to $164 million. Conclusions and Relevance: In this cohort study of active-duty US Army soldiers, embedding an interdisciplinary occupational health system directly into the workplace was associated with a significantly accelerated recovery time from musculoskeletal injuries. These findings suggest that employer-sponsored occupational health interventions are a scalable strategy to reduce injury-related absenteeism and enhance workforce productivity, particularly in high-risk industries.