Long-Term Outcomes of Service Women Injured on Combat Deployment

Mental and Physical Health-Related Quality of Life Following Military Polytrauma

INTRODUCTION

The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends.

MATERIALS AND METHODS

The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures.

RESULTS

Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002).

CONCLUSIONS

Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.

Physical activity and perceived barriers in individuals with moderate-to-severe traumatic brain injury

INTRODUCTION

Regular physical activity (PA), especially aerobic exercise, may benefit cognitive function in middle-aged and older adults, but promoting regular PA in individuals with traumatic brain injury (TBI) remains a challenge.

OBJECTIVE

To characterize PA and perceived barriers to PA in younger (<45 years) and middle age and older (≥45 years) individuals ≥1 year after moderate-to-severe TBI.

DESIGN

Multicenter survey study.

SETTING

Community.

PARTICIPANTS

Persons who met the following criteria were included in the study: (1) 18 years and older; (2) English speaking; (3) History of moderate-to-severe TBI; (4) Followed in a TBI Model Systems Center for at least 1 year; and (5) Able to complete the survey independently.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURE(S)

PA level measured by Rapid Assessment of Physical Activity questionnaire (RAPA) and self-reported barriers to PA.

RESULTS

A total of 472 participants completed the survey (response rate of 21%). More individuals in the younger group (<45 years old) met Centers for Disease Control and Prevention (CDC) recommended aerobic PA guidelines compared to the middle-aged and older group (≥ 45 years old) (62% vs 36%, p < .001). Lack of motivation, lack of time, and fatigue were the most reported barriers. Perceived barriers to PA varied by age and PA level: the middle-aged and older individuals (≥ 45 years old) were more likely to report no barriers and inactive individuals (RAPA ≤5) more likely to report lack of motivation and money, pain, and lack of resources.

CONCLUSION

Participants ≥45 years of age were less likely to meet the CDC PA guidelines than younger individuals after moderate-to-severe TBI. Because perceived barriers to PA varied between age groups and PA levels, individualized approaches may be needed to promote PA in this population.

Deployment-related concussion and long-term health-related quality of life among US military personnel

PURPOSE

To examine the relationship between deployment-related concussion and long-term health-related quality of life (HRQoL) among injured US military personnel.

METHODS

The study sample included 810 service members with deployment-related injuries between 2008 and 2012 who responded to a web-based longitudinal health survey. Participants were categorized into three injury groups: concussion with loss of consciousness (LOC; n = 247), concussion without LOC (n = 317), or no concussion (n = 246). HRQoL was measured using the 36-Item Short Form Health Survey physical and mental component summary (PCS and MCS) scores. Current post-traumatic stress disorder (PTSD) and depression symptoms were examined. Multivariable linear regression models assessed the effects of concussion on PCS and MCS scores, while controlling for covariates.

RESULTS

A lower PCS score was observed in participants with concussion with LOC (B =  - 2.65, p = 0.003) compared with those with no history of concussion. Symptoms of PTSD (PCS: B =  - 4.84, p < 0.001; MCS: B =  - 10.53, p < 0.001) and depression (PCS: B =  - 2.85, p < 0.001; MCS: B =  - 10.24, p < 0.001) were the strongest statistically significant predictors of lower HRQoL.

CONCLUSION

Concussion with LOC was significantly associated with lower HRQoL in the physical domain. These findings affirm that concussion management should integrate physical and psychological care to improve long-term HRQoL and warrant a more detailed examination of causal and mediating mechanisms. Future research should continue to incorporate patient-reported outcomes and long-term follow-up of military service members to further define the lifelong impact of deployment-related concussion.

Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020

ABSTRACT

Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.