6 October 2025

New Study Shows How Point of Entry into Care Impacts Soldier Recovery

MIRROR research reveals that direct access to physical therapy improves outcomes in musculoskeletal injury care

Redesigning Musculoskeletal Injury Care for Readiness

For active-duty Soldiers, musculoskeletal injuries are a leading cause of medical visits, restricted duty time, and lost readiness. However, where a Soldier enters the healthcare system may significantly affect not only their recovery outcomes but also whether they return to full duty at all.

A recent study published in Military Medicine by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) program— “The Impact of a Unique Military Treatment Facility-Based Sports Medicine Model on Readiness in the Army”—examines how different care pathways affect recovery timelines, recurrence rates, and return-to-duty status.

Among the study’s authors are Sean Suttles, SP, USA (Ret.); Riley R. Boeth; Mathew Frazier, DPT; Michael Garrison, SP, USA (Ret.); and Brad Isaacson, PhD, MBA, MSF, PMP. Dr. Isaacson is a member of the Geneva team and the Chief of Research and Operations for MIRROR. Geneva served as the prime awardee and project manager for this multi-year research initiative.

Direct Access = Shorter Recovery, Fewer Recurrences

Researchers followed 488 Soldiers who sought care for an initial musculoskeletal injury over a two-year period at a Military Treatment Facility (MTF). Patients either entered through:

 

• • Direct Access (DA): where care began immediately with a physical therapist
  • Early Access PT (EAPT) Referral Pathway: which required initial provider referral and additional administrative steps

 

Key findings:

• • Recurrence rates were nearly twice as high for Soldiers referred through the EAPT pathway compared to DA
  • Soldiers in the DA group had a shorter duration of care and were significantly more likely to return to duty without limitations
  • Time from injury to treatment mattered, but pathway type had a stronger predictive impact on outcomes than timing alone

 

These results suggest that adopting a sports medicine–style clinic model, with DA care embedded within MTFs, can enhance readiness by reducing recurrence and accelerating recovery.

Realigning Military Care Models with Performance Outcomes

This retrospective, longitudinal cohort study supports ongoing efforts to align military medicine with high-performance sports care, thereby bridging the gap between conventional clinical settings and the realities of operational readiness.

Through Geneva’s role as prime awardee and project manager, this research highlights how evolving care models can shape better outcomes for Soldiers and offer scalable solutions across the Military Health System.

To learn more about Geneva’s work in injury rehabilitation, military performance optimization, and operational medicine, visit our Operational Medicine focus area page.

This work was funded in part by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR), Department of Physical Medicine & Rehabilitation, Uniformed Services University, Bethesda, MD (HU00011920011). Visit the MIRROR website to learn more about the MIRROR program.

The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.