MORE Resiliency in the Rehabilitation of Active Duty Service Members
Abstract
Lower extremity trauma is the largest burden of injury from current military conflicts, representing 64% of a projected $1.9 billion in disability benefit costs and causing the largest percentage of days on limited duty. More important than the incidence and cost of these injuries is the effect lower extremity injury can have on the general health and quality of life of the Service member. Both civilian and military studies examining outcomes following extremity trauma demonstrate a significant negative effect on long-term physical function and the ability to work and participate in recreational activities. While not all deployment-related injuries have such a profound impact on the life of the Service member, the need to improve recovery and long-term function following extremity injury is evident. Resiliency (i.e., the process of negotiating, managing, and adapting to a traumatic event) is an important multidimensional psychosocial construct that has received increased attention in both the civilian and military orthopaedic trauma literature. Individuals with high resiliency are more likely to positively adapt when recovering from trauma. Studies also demonstrate that resiliency involves behaviors, thoughts, and actions that can be modified and skills to promote resiliency can be learned. Therefore, it is critical that rehabilitation specialists identify individuals with low resiliency in order to improve outcomes after lower-extremity injury. This 3-year application is directly aligned with the Fiscal Year 2015 Peer Reviewed Orthopaedic Research Program rehabilitation focus area of Rehabilitation Outcomes. This focus area is on the development of validated, standardized measures to objectively assess and improve rehabilitation outcomes, including psychosocial resiliency and reintegration, following severe injury. The purpose of our proposed multicenter prospective cohort study is to address important knowledge gaps on resiliency in the rehabilitation of Service members with lower-extremity injuries. Specific aims are to develop and test a resiliency instrument that is relevant to active duty military Service members. The proposed project will leverage the infrastructure of the Maximizing Outpatient Rehabilitation Effectiveness (MORE) study that is currently being conducted at two military sites. The first year of the project will focus on selecting items from three well-established resiliency instruments that have been validated in civilian populations. Interviews and focus groups will be conducted in 44 active duty military Service members already enrolled in the MORE study in order to select items for the MORE resiliency instrument. A pretest in 50 Service members will finalize the instrument, and testing in 310 Service members will occur in the second and third year of the project. Testing will occur to determine the reliability and construct and predictive validity of the MORE resiliency instrument in active duty Service members with lower-extremity injury. Results from the proposed study will provide an evidence-based resiliency instrument that can be immediately integrated into rehabilitation care in the military setting. This study will also provide critical data on resiliency as a predictor of rehabilitation outcomes. Our instrument will help physical therapists and other healthcare providers identify Service members who could benefit from additional skills associated with resiliency (social skills, problem-solving, relaxation, positive coping). Thus, rehabilitation specialists will be able to help Service members develop resilience early in the rehabilitation process, which will provide individuals with a greater chance of restoring function, returning to duty, and participating in social roles. In the long term, our instrument can assist with the development of interventions to improve reintegration following traumatic injury and assess the benefits of integrating specific resiliency skill
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1620061
Entities
People
- Kristin Archer Swygert
Organizations
- United States Army
- Vanderbilt University