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To Investigate Musculoskeletal Status and Mental State of Female Recruits During Training

: 5 Objective: To investigate the musculoskeletal status and psychological status of female recruits 6 during military boot enlistment training. Methods: The musculoskeletal status and psychological 7 status of 110 boot training patients were assessed by scale, the psychological status of the 8 subjects was assessed by Zung Anxiety Self-Rating Scale and Zung Depression Self-Evaluation 9 Scale, the musculoskeletal status was assessed by visual analogue scale, Neck disability index, 10 JOA low back pain evaluation form, Knee injury and Osteoarthritis Outcome Score scale, the 11 medical document data during boot training were collated, and the risk factors affecting physical 12 and mental health were analyzed. Thus, interventions are taken to reduce the injury rate and 13 improve training performance. Results: Logistic regression analysis showed that neck dysfunction 14 was a risk factor for depressive state and lumbar dysfunction; lumbar dysfunction was a risk 15 factor for anxiety state, neck dysfunction and pain symptoms around the knee joint; pain around 16 the knee joint was a risk factor for lumbar dysfunction and a protective factor for neck 17 dysfunction; anxiety state was a risk factor for depressive state; depression state was a risk factor 18 for anxiety state and neck dysfunction; and young age was a protective factor for anxiety state. Conclusion: In 10 weeks of military training, the site with the highest musculoskeletal injury is 20 around the knee joint, followed by the neck and waist. Knee injury and Osteoarthritis Outcome 21 Score scale scores were significantly associated with mental health status, with neck dysfunction 22 increasing the risk of depression and lumbar dysfunction increasing the risk of anxiety in recruits. 23 Prevention and treatment need to pay attention to these parts, gradually improve the balance, 24 flexibility, strength of the body, while paying close attention to the mental health of recruits, so as 25 to reduce the rate of injury. 26


Introduction 28
After enlistment, regular training includes team training, military training, political education 29 and mental health education. Basic military training is physically and psychologically demanding, 30 leaving recruits at high risk of injury. Musculoskeletal conditions are the largest contributor to the 31 overall disease burden, accounting for 39.1% of all diagnoses, followed by mental health 32 (10.4%) (1). Musculoskeletal injury (MSI) in military populations is a serious problem. This type of 33 injury is typically characterized by pain, mobility difficulties, dexterity, and functional capacity 34 limitations. Low back pain, in particular, reduces work ability and training efficiency and increases 35 the burden on related health services(2).Studies have shown that recruits are more likely to 36 5 symptoms. Add the scores of 20 questions as the crude score, multiply the crude score by 1.25, 86 round to integer, and obtain the standard score. The cut-off values for anxiety ratings were less 87 than 46 for normal; 46-50 for mild anxiety; and greater than 50 for severe anxiety. The cut-off 88 values for depression rating were 25-49 points for normal, 50-59 points for mild depression, 89 60-69 points for moderate depression; and 70 points and above for severe depression. 90

Visual Analogue Scale (VAS) 91
Recruits chose a score based on their self-perception, which was used to indicate the degree 92 of pain, with a higher score indicating more severe pain. 0 points: no pain; 1-3 points: Mild pain, 93 tolerable; 4-6 points: Moderate pain, sleep disturbance, tolerable; 7-10 points: Severe pain, 94 unbearable, affecting appetite and sleep. 95

Neck disability index (NDI) 96
Scores from the Neck Dysfunction Assessment program were added to the final score. Each 97 item has a minimum score of 0 and a maximum score of 5. The higher the score is, the more 98 serious the dysfunction is. The degree of cervical function impairment of the subjects was 99 calculated according to the following formula: cervical function impairment index (%) = (sum of 100 the scores of each item/number of items completed by the subjects × 5) × 100%. Judgment of 101 NDI results: 0-20% indicates mild dysfunction; 20-40% indicates moderate dysfunction; 40-60% 102 indicates severe dysfunction; 60-80% indicates very severe dysfunction; 80-100% indicates 103 complete dysfunction or subjects should be examined in detail for exaggerated symptoms. 104

JOA Low Back Pain Evaluation Form 105
The full score of this scale is 29 points; 16-24 points are good; 25-29 points are excellent; 106 10-15 points are moderate; and less than 10 points are poor; it is clinically used to quantitatively 107 6 evaluate the severity and improvement of low back pain. 108

Knee injury and Osteoarthritis Outcome Score (KOOS) 109
This scale is a subjective instrument to evaluate sports injury. This score mainly includes five 110 aspects: pain (9 items), symptoms (7 items), daily activities (17 items), sports and recreational 111 functions (7 items) and knee-related quality of life (4 items). Each question is divided into five 112 levels: 0-4, and the summary score of each aspect is converted into a standard score (minimum 113 score 0-maximum score 100). The scores of all five parts of the KOOS score were analyzed 114 separately without adding a total score analysis(10). 115

Statistical analysis 116
All data was statistically analyzed using SPSS 20.0 statistical software. Descriptive analysis 117 was performed on the data of basic information age, BMI, Zung Anxiety Self-Rating Scale, Zung 118 Depression Self-Evaluation Scale, NDI, JOA low back pain evaluation form, KOOS, and VAS score of 119 the subjects and Spearman correlation analysis was performed between each variable. 120 Continuous variables were converted into categories, and binary logistic regression analysis was 121 performed to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of the variables 122 and assess the association between the variables and the risk of injury. 123

201
Soldiers with depressive state were more likely to have anxiety state, neck dysfunction 202 than soldiers without depressive state. Older soldiers were more likely to experience 203 anxiety than younger soldiers.

11
That means, neck dysfunction is a risk factor for depressive state and lumbar 205 dysfunction; lumbar dysfunction is a risk factor for anxiety state, neck dysfunction and 206 pain symptoms around the knee joint; pain around the knee joint is a risk factor for lumbar 207 dysfunction and a protective factor for neck dysfunction; anxiety state is a risk factor for 208 depressive state; depressive state is a risk factor for anxiety state and neck dysfunction; 209 and young age is a protective factor for anxiety state.