Rehabilitation Needs of Combat-Injured Service Members Admitted to the VA Polytrauma Rehabilitation Centers: The Role of PM&R in the Care of Wounded Warriors

Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN, USA.
PM&R (Impact Factor: 1.53). 02/2009; 1(1):23-8. DOI: 10.1016/j.pmrj.2008.10.003
Source: PubMed


To describe the rehabilitation course of combat-injured service members who sustained polytraumatic injuries during the current wars in and around Iraq and Afghanistan.
Retrospective descriptive analysis.
Department of Veterans Administration Polytrauma Rehabilitation Centers (PRCs).
One hundred eighty-eight consecutive, acutely combat-injured service members suffering polytraumatic injuries requiring inpatient rehabilitation and being treated at PRCs between October 2001 and January 2006.
Not applicable.
Medications prescribed, devices used, injuries and impairment information, and consultative services.
Ninety-three percent of the patients had sustained a traumatic brain injury (TBI) and more than half of these were incurred secondary to blast explosions. Over half of the patients had infections or surgeries prior to PRC admission that required continued medical attention during their stay. Pain and mental health issues were present in 100% and 39%, respectively, of all patients admitted and added complexity to the brain injury rehabilitation process. Common treatment needs included cognitive-behavioral interventions, pain care, assistive devices, mental health interventions for both patients and their families, and specialty consultations, in particular to ophthalmology, otolaryngology, and neurology.
Combat-injured polytrauma patients have complex rehabilitation needs that require a high level of specialized training and skill. Physical medicine and rehabilitation specialists treating war injured service members need a high level of expertise in assessment and treatment of co-occurring pain, TBI, and stress disorders. Physiatrists are playing an important role in providing and coordinating the rehabilitation care for individuals with significant polytraumatic war injuries from the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts.

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    • "Please cite this article in press as: Mordeno, I.G., et al., Examining posttraumatic stress disorder's latent structure between treatmentseeking and non-treatment-seeking Filipinos. Asian J. Psychiatry (2014), experience supportive environment (Sayer et al., 2009). This study is intended to address two major objectives: first, to examine the most supported PTSD models in an Asian sample, particularly Filipinos, to determine cross-cultural generalizability; and second, to assess if a particular type of grouping (i.e., treatment-seeking vs. nontreatment-seeking ) moderates PTSD's latent structure. "
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    ABSTRACT: Background The discourse of latent structure of posttraumatic stress disorder (PTSD) has been extensive in trauma literature. Although findings have been consistent in rejecting DSM-IV-TR's three-factor model, alternative models are still fervently argued. This study contributes to the discussion by examining PTSD factor structure of the three most validated models—numbing model (King et al., 1998), dysphoria model (Simms et al., 2002), and dysphoric arousal model (Elhai et al., 2011b)—and determining if these are generalizable across treatment-seeking and non-treatment-seeking Filipinos with exposure to trauma events. Methods Filipino-Tagalog version of Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) was administered to treatment-seeking (n = 526) and non-treatment-seeking (n = 211) Filipinos who experienced and witnessed varied trauma events. Confirmatory factor analysis (CFA) was conducted involving the three models in order to determine the best-fitting model and generalizability across samples. Results Results showed that all three models achieved excellent fit, with dysphoric arousal model slightly fitting better than numbing and dysphoria models in both treatment-seeking and non-treatment-seeking samples.The data further revealed that aside from the factor loadings, the two groups are noninvariant in all parameters. Treatment-seeking sample had larger intercepts, factor variances and covariances and factor means than non-treatment-seeking group. Discussion The findings strongly contribute to the literature by showing how the type of groupings (treatment-seeking vs. non-treatment-seeking) moderates PTSD latent structure. It affirms the suggestion of Biehn et al. (2012) to be cautious in concluding the generalizability of PTSD models in the context that type of participants moderates PTSD's factor structure.
    Asian Journal of Psychiatry 06/2014; 11. DOI:10.1016/j.ajp.2014.05.003
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    • "How best to improve access and, once a problem is identified, improve treatment engagement, is an important topic for both policy makers and researchers. Such interventions should target not only veterans themselves , but also their social networks which can play a crucial role in promoting veteran help-seeking, even for stigmatized conditions such as PTSD (Sayer et al., 2009). This review also highlights the absence of research on veterans who do not use the VA for healthcare. "
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    ABSTRACT: Although the majority of combat veterans reintegrate into civilian life without long-lasting problems, a sizable minority return from deployment with psychiatric or physical injuries that warrant medical attention. Even in the absence of diagnosable disorders, many experience functional problems that impede full reintegration into civilian life. Considerable resources have been allocated to studying, diagnosing, treating, and compensating combat-related disorders. This important work has resulted in significant improvements in healthcare for those with deployment-related difficulties. Nevertheless, many service members and veterans with reintegration difficulty may not receive needed help. Based on our review, we argue that in addition to treatment and compensation for diagnosable postdeployment problems, a comprehensive approach to reintegration is needed that includes partnership between the government, private sector, and the public.
    Social Issues and Policy Review 01/2014; 8(1). DOI:10.1111/sipr.12001
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    • "As previously stated, these veterans are often diagnosed with physical, emotional, and psychosocial conditions that require a customized approach to coordinating care. Veterans or SMs identified with conditions such as traumatic brain injury, spinal cord injury, blindness, severe burns, amputations, and severe mental health issues may have their case management provided by specialty care programs and case managers as found in the PSC (Sayer et al., 2009). Due to the clinical complexity of the aforementioned cohort, polytrauma specialty case managers serve as the lead case manager for patients as they move through the rehabilitation and recovery continuum with the primary responsibility of transitioning veterans and SMs seamlessly across VA levels of care while coordinating resources to meet medical and psychosocial needs (Department of Veterans Affairs, 2009b). "
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    ABSTRACT: Purpose: The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the "signature injury" of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. Findings/conclusions: The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. Clinical relevance: The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 09/2013; 38(5). DOI:10.1002/rnj.102 · 1.15 Impact Factor
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