Current perspectives of late-stage rehabilitation and return to duty criteria following lower limb musculoskeletal injury in military personnel: a practitioner survey

Introduction: Lower limb musculoskeletal injuries (MSKIs) are a leading cause of reduced operational capability and medical discharge in UK military personnel. Late-stage rehabilitation (LSR) is critical for restoring function and readiness for return to duty (RTD) yet remains under-represented in research and clinical guidelines. This service evaluation examines current practices, perspectives and challenges among UK Defence rehabilitation practitioners and physical training instructors (PTIs) in delivering LSR and facilitating RTD for lower limb MSKIs. 

Methods: A cross-sectional survey was distributed to UK Defence rehabilitation practitioners and Army PTIs. The survey collected demographic, quantitative and qualitative data on LSR exercises, outcome measures, RTD criteria and perceived challenges. Quantitative data were analysed descriptively; qualitative responses were examined using inductive content analysis. 

Results: 157 responses were received across all services and levels of care, with respondents averaging 8 years of clinical experience. LSR commonly included resistance training, plyometrics, running and load carriage. PTIs most frequently reported low cardiovascular fitness as a deficit persisting after rehabilitation. A range of outcome measures was used to guide progression and RTD; however, there was inconsistency regarding their relevance and application across all branches of the UK military. Only 48% of rehabilitation practitioners reported using a formal RTD criteria, while 78% used structured handover tools. Common challenges included time constraints, limited access to resources and low patient compliance and confidence. 

Conclusion: LSR and RTD practices for lower limb MSKIs are variable across military rehabilitation settings. There is a clear need to balance standardisation with individualised care based on patient needs and occupational roles. Clear role delineation and communication between rehabilitation practitioners and PTIs are essential during the transition phase. Addressing persistent challenges such as limited time, resources, deconditioning, rehabilitation compliance and psychological readiness may improve LSR effectiveness.