Does Self-efficacy Predict Outcomes Among U.S. Military Academy Cadets During Initial Entry Training?

Background:

Lower back injuries are a common occurrence in athletes, sports programs, and in the military (Bengtsson, 2018; Lovalekar, 2021). The Army's new fitness test includes a three-repetition maximum deadlift, and this inclusion has raised concern amongst servicemembers and healthcare workers due to the association between deadlifts and lower back injuries. There is debate amongst researchers about the role of deadlift form in lower back injury prevention, specifically related to flexion of the spine (Sjoberg, 2020).

Purpose:

The purpose of this study is to investigate the effect of low back pain education (either cautionary regarding injury risk or reassuring regarding spine resiliency) on deadlift performance (weight lifted), and if this education has an effect on self-efficacy and perceived spine vulnerability.

Participants:

Participants will be incoming new cadets at the United States Military Academy (USMA). Inclusion criteria are cadets age 17-26 (cadets under the age of 18 are legally emancipated therefore able to consent), those participating in the ACFT, and speak and understand English.

Study Design:

This study will be a randomized controlled trial with parallel design and 1:1 allocation ratio. The investigators plan to use cluster randomization. There will be three groups- control, cautionary, reassuring (Jackson, 2005). The investigators are also planning a prospective cohort study to assess self-efficacy, injury, and performance over time.

Procedures:

Data will be collected at the United States Military Academy during the summer of 2022 during cadet basic training. Shortly after new cadets arrive at USMA, the investigators will gather demographic and initial self-efficacy information. The randomized control element of this study will occur before and during the maximum deadlift (MDL) of the Army Combat Fitness Test (ACFT). At the start of cadet basic training, investigators will randomly allocate each company of cadets into one of three groups (three companies per group.) The investigator will administer the education (cautionary, reassuring, or control) shortly prior to cadets taking the MDL, and will collect results after the ACFT. The cautionary education is similar to standard information provided to many servicemembers before the start of an ACFT or a maximum deadlift.

Study Overview

• Status: Completed
• Conditions: Low Back Pain; Musculoskeletal Injury
• Intervention / Treatment: Behavioral: Deadlift Form Education

Detailed Description

Background:

Musculoskeletal injuries (MSKIs) are the leading cause of nondeployability, lost duty days (LDD), medical encounters, military discharge, and disability in the United States Military. (Lovalekar, 2021). Ironically, the leading causes of MSKIs are same activities that leaders deliberately conduct to develop physical resilience: running, foot marching, other physical fitness training activities (besides running) and work-related tasks (Lovalekar, 2021).

Purpose:

The purpose of this study is to learn about relationships between self-efficacy, injury and physical/tactical performance. The investigators also plan to assess the effect of low back pain education (either cautionary regarding injury risk or reassuring regarding spine resiliency) on deadlift performance (weight lifted), and if this education has an effect on self-efficacy and perceived spine vulnerability.

Participants:

Participants will be incoming new cadets at the United States Military Academy (USMA). Inclusion criteria are cadets age 17-26 (cadets under the age of 18 are legally emancipated therefore able to consent), those participating in the ACFT, and speak and understand English.

Study Design:

This study will be a randomized controlled trial with parallel design and 1:1 allocation ratio. The investigators plan to use cluster randomization. There will be three groups- control, cautionary, reassuring (Jackson, 2005). The investigators are also planning a prospective cohort study to assess self-efficacy, injury, and performance over time.

Procedures:

Data will be collected at the United States Military Academy during the summer of 2022 during cadet basic training. Shortly after new cadets arrive at USMA, the investigators will gather demographic and initial self-efficacy information. The randomized control element of this study will occur before and during the maximum deadlift (MDL) of the Army Combat Fitness Test (ACFT). At the start of cadet basic training, researchers will randomly allocate each company of cadets into one of three groups (three companies per group.) The researchers will administer the education (cautionary, reassuring, or control) shortly prior to cadets taking the MDL, and will collect results after the ACFT. The cautionary education is similar to standard information provided to many servicemembers before the start of an ACFT or a maximum deadlift.

• Study Type: Interventional
• Enrollment (Actual): 903
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • West Point, New York, United States, 10996
      • Keller Army Community Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years to 26 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All incoming US Military Academy cadets, attending cadet basic training in summer 2022.

Exclusion Criteria:

• Unable to communicate in English; unable to participate in deadlift event.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cautionary; The group will receive a message regarding potential risk for spine injury before the tested task.	Behavioral: Deadlift Form Education; The education will include information about the lumbar spine as it relates to a deadlift. The researchers will administer this education shortly prior to participants taking a strength test.
Experimental: Reassuring; This group will receive a message regarding spine resiliency before the tested task.	Behavioral: Deadlift Form Education; The education will include information about the lumbar spine as it relates to a deadlift. The researchers will administer this education shortly prior to participants taking a strength test.
No Intervention: Control; This group will not receive education before the tested task.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Deadlift Weight Lifted	Weight lifted for three repetitions	Following the intervention. This event/data collection took place at a single time point immediately following the intervention, up to 30 minutes
Perceived Spine Vulnerability, Q1	Ease of which participants believe the back can be injured, "it is easy to injure your back". Questions based on Back Pain Attitude Questionnaire, item 6. Count reflects the number of participants who selected "true"	Immediately after the intervention
Perceived Spine Vulnerability, Q2	Ease of which participants believe the back can be injured, "you could injure your back if you are not careful". Questions based on Back Pain Attitude Questionnaire, item 11. Count reflects the number of participants who selected "true"	Immediately after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Deadlift Self-Efficacy Questionnaire	Self-efficacy related to the deadlift was gathered by a single numeric rating scale question. Participants were asked to rate their confidence in succeeding at the deadlift event, from "not confident at all - 0" to "fully confident - 10).	Outcome data was collected immediately following the intervention

Collaborators and Investigators

• Sponsor: Keller Army Community Hospital

Publications and helpful links

General Publications

• Jackson T, Pope L, Nagasaka T, Fritch A, Iezzi T, Chen H. The impact of threatening information about pain on coping and pain tolerance. Br J Health Psychol. 2005 Sep;10(Pt 3):441-51. doi: 10.1348/135910705X27587.
• Bengtsson V, Berglund L, Aasa U. Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift. BMJ Open Sport Exerc Med. 2018 Jul 17;4(1):e000382. doi: 10.1136/bmjsem-2018-000382. eCollection 2018.
• Lovalekar M, Hauret K, Roy T, Taylor K, Blacker SD, Newman P, Yanovich R, Fleischmann C, Nindl BC, Jones B, Canham-Chervak M. Musculoskeletal injuries in military personnel-Descriptive epidemiology, risk factor identification, and prevention. J Sci Med Sport. 2021 Oct;24(10):963-969. doi: 10.1016/j.jsams.2021.03.016. Epub 2021 Mar 31.
• Sjoberg H, Aasa U, Rosengren M, Berglund L. Content Validity Index and Reliability of a New Protocol for Evaluation of Lifting Technique in the Powerlifting Squat and Deadlift. J Strength Cond Res. 2020 Sep;34(9):2528-2536. doi: 10.1519/JSC.0000000000002791.
• Scott KM, Kreisel BR, Florkiewicz EM, Crowell MS, Morris JB, McHenry PA, Benedict TM. The Effect of Cautionary Versus Resiliency Spine Education on Maximum Deadlift Performance and Back Beliefs: A Randomized Control Trial. J Strength Cond Res. 2024 Jul 1;38(7):e341-e348. doi: 10.1519/JSC.0000000000004783. Epub 2024 May 28.

Study record dates

Study Major Dates

• Study Start (Actual): July 4, 2022
• Primary Completion (Actual): August 2, 2022
• Study Completion (Actual): June 8, 2023

Study Registration Dates

• First Submitted: July 1, 2022
• First Submitted That Met QC Criteria: July 6, 2022
• First Posted (Actual): July 12, 2022

Study Record Updates

• Last Update Posted (Estimated): November 4, 2025
• Last Update Submitted That Met QC Criteria: October 21, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Self-Efficacy; Nocebo
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: KACH.2022.0053

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No