Aaron P Turner

• PhD
• Managing Director at VA Puget Sound Health Care System

Purpose/Objective: This cross-sectional study applied the self-regulation resource model of self-compassion to people with multiple sclerosis (PwMS). We examined the role of body compassion as a resilience resource and its associations with self-regulation resources (affect and self-efficacy) and health behaviors (substance use, exercise, and socia...

BACKGROUND The role of resilience on functional outcomes in multiple sclerosis (MS) has been debated. One theorized pathway is that healthy lifestyle behaviors contribute to better functioning capabilities, which resilient individuals with MS tend to engage in more. This study aimed to explore whether resilience might influence functioning in indiv...

Objective To evaluate the criterion and construct validity of the 7-category Amputee Single Item Mobility Measure (AMPSIMM) in a large contemporary dysvascular lower limb amputation population and propose an abbreviated 4-category version (AMPSIMM-4) whose mobility categories parallel the Medicare Functional Classification Levels (K-levels). Desig...

BACKGROUND Despite unequivocal evidence for the benefits of regular physical activity (PA), many people with multiple sclerosis (MS) and their family caregivers find it challenging to fully participate to the same extent as the general population. Achieving full participation in PA requires addressing both quantity and quality of participation. Alt...

Purpose: This study aimed to evaluate 1) whether having a vascular comorbidity (i.e., hypertension, hyperlipidemia, heart disease, and diabetes) was associated with self-reported issues with functional activities among persons with multiple sclerosis (MS) and 2) if certain contributing factors (i.e., disability, depression, and fatigue) might expl...

BACKGROUND Multiple sclerosis (MS) disease factors, such as cognitive impairment, can cause disruptions in meaningful activities, also known as illness intrusiveness. Although the association between specific objective measures of cognition and illness intrusiveness has been documented in MS, the contributions of individuals’ perceptions of their c...

We need a better approach to patients with low back pain (LBP). Current care is plagued by variability, over-medicalization of biopsychosocial problems, inequity, and an overemphasis on interventional and surgical care. Guidelines focused on the short-term management of acute LBP are generally not followed and have limited applicability in clinical...

Objective To examine the relationships between intraindividual cognitive variability (IIV) and self-reported cognitive and functional difficulties in persons with multiple sclerosis (pwMS). We hypothesized higher perceived cognitive and functional difficulties would be associated with higher IIV. Method Participants (n = 35) were pwMS from a prosp...

Objective To determine the prevalence of peripheral neuropathy (PN) and its effect on mobility in patients who were prescribed a lower limb prosthesis (LLP) after an incident dysvascular transtibial (TT) or transfemoral (TF) lower extremity amputation (LEA). We also sought to determine if the effect of PN on mobility was modified by amputation leve...

Background Non‐Hispanic Black (NHB) individuals have higher rates of amputation and increased risk of a transfemoral amputation due to dysvascular disease than non‐Hispanic White (NHW) individuals. However, it is unclear if NHB individuals have differences in prosthesis use or functional outcomes following an amputation. Objective To determine if...

Objective: Chronic opioid use presents long-term health risks for individuals with spinal cord injury (SCI). The purpose of the study was to characterize patterns and correlates of the chronic prescription of opioids among individuals with SCI in a population of Veterans receiving care though the Veteran's Health Administration. Design: A retros...

Objective: Clinical trials often focus on symptom reduction as a primary outcome, overlooking positive psychology factors of potential importance although many individuals can and do live well with pain. The Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Illness Impact—Positive (PIIP) scale assesses perceptions of ad...

Introduction: Chronic lung disease (CLD) has been associated with risk for more severe manifestations and death with COVID-19. However, few studies have evaluated the risk overall and by type of CLD for severity of COVID-19 outcomes in a US national cohort. Methods: Using data from the Veterans Health Administration, we determined the risk assoc...

Objective Mild traumatic brain injury (mTBI), depression, and posttraumatic stress disorder (PTSD) are a notable triad in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans. With the comorbidity of depression and PTSD in Veterans with mTBI histories, and their role in exacerbating cognitive and emotio...

Introduction Mild traumatic brain injury (mTBI), depression, and PTSD are highly prevalent in post-9/11 veterans. With the comorbidity of depression and PTSD in post-9/11 veterans with mTBI histories and their role in exacerbating cognitive and emotional dysfunction, interventions addressing cognitive and psychiatric functioning are critical. Compe...

Background: Women with lower extremity amputations (LEAs) tend to have poorer prosthesis-related outcomes than men, though the literature is sparse. There are no prior studies examining prosthesis-related outcomes of women Veterans with LEAs. Objective: We examined gender differences (overall and by type of amputation) among Veterans who underwe...

Objective: To examine the value of including an open label phase after a clinical trial of pain treatments by examining participant characteristics and potential benefits. Method: Secondary data analysis. Veterans with chronic pain who completed a randomized controlled trial (RCT) comparing hypnosis, mindfulness meditation, and pain education were...

Purpose/objective: To examine the impact of three behavioral interventions for chronic pain on substance use. Research method/design: Participants were 328 Veterans with chronic pain receiving care at one of two Veterans Affairs Medical Centers in the northwest United States. Participants were randomly assigned to one of three 8-week manualized...

Background Cognitive dysfunction and brain atrophy are both common in progressive multiple sclerosis (MS) but are seldom examined comprehensively in clinical trials. Antioxidant treatment may affect the neurodegeneration characteristic of progressive MS and slow its symptomatic and radiographic correlates. Objectives This study aims to evaluate cr...

Objective: To characterize patterns of prescription opioid use among individuals with MS and identify risk factors associated with chronic use. Design: Retrospective longitudinal cohort study examining US Department of Veterans Affairs electronic medical record data of Veterans with MS. The annual prevalence of prescription opioid use by type (a...

Background: Shared decision-making (SDM) is increasingly advocated in the care of vascular surgery patients. The goal of this investigation was to gain a greater understanding of the patient and provider experience of SDM during clinical decision-making around the need for lower-extremity amputation and amputation level related to chronic limb-thr...

Purpose: To determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease. Materials and methods: A retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis...

Background: Self-management programs have been used with success in several clinical populations, and there is a growing body of evidence to support their use among persons with multiple sclerosis (MS). This group aimed to develop a novel self-management program, Managing My MS My Way (M4W), which is based in social cognitive theory and contains e...

Objective: To evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors. Design: Retrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases. Setting: VHA patients throughout the United States. Participants: The s...

Background: There has yet to be an examination of how appointment attendance behaviors in multiple sclerosis (MS) are related to scheduling metrics and certain demographic, clinical, and behavioral factors such as cognitive functioning and personality traits. This study aimed to examine the factors that differ between no shows (NS), short notice c...

Background: Among patients facing lower extremity amputation due to dysvascular disease, mortality risk is very high. Given this, as well as the importance of a patient-centered approach to medical care, informing patients about their possible risk of dying may be important during pre-operative shared decision-making. The goal of this investigatio...

Unlabelled: AMPREDICT PROsthetics- Predicting Prosthesis Mobility to aid in prosthetic prescription and rehabilitation planning. Objective: To develop and validate a patient-specific multivariable prediction model that utilizes variables readily available in the electronic medical record to predict 12-month mobility at the time of initial post-a...

Purpose/objective: While personality traits have been well-documented to be related to resilience in several populations, they have yet to be explored in people with multiple sclerosis (PwMS). As such, this study aimed to understand how personality traits are associated with MS-related resilience after considering the independent contributions of...

Background The Multiple Sclerosis Resiliency Scale (MSRS) was designed to assess factors connected to resilience when facing MS-related challenges. Although the MSRS has demonstrated good internal consistency and construct validity, its test-retest reliability has yet to be established. Identifying the minimal detectable change (MDC) of the scale w...

Background Women Veterans with amputation are a group with unique needs whose numbers have grown over the last 5 years, accounting for nearly 3% of all Veterans with amputation in 2019. Although identified as a national priority by the Veterans Health Administration, the needs of this population have remained largely underrepresented in amputation...

Objectives: Difficulties with prospective memory (PM) are not routinely assessed in persons with multiple sclerosis (MS) even though they can impact daily functioning. This study aimed to examine the preliminary criterion and ecological validity of a highly abbreviated Memory for Intentions Test (MIST) intended to serve as an initial screening of P...

Background: While comorbidities have been associated with all-cause hospitalizations among persons with multiple sclerosis (MS), there has been no examination of their role in all-cause emergency department (ED) utilization. As such, this study aimed to determine if the presence of comorbidities increases the odds of ED usage in a national sample o...

Purpose There is limited qualitative research on the experience of patients undergoing lower limb amputation due to chronic limb threatening ischemia (CLTI) and their participation in amputation-level decisions. This study was performed to understand patient lived experiences related to amputation and patient involvement in shared decision making....

Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) to an active education control (ED). Veterans (N=328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), o...

Objective: To examine the relationship between neuropsychological functioning and performance-based functional capacity in Veterans with a history of mild traumatic brain injury (mTBI), as well as the moderating effect of age and psychiatric symptoms on this relationship. Setting: Three VA medical centers. Participants: One hundred nineteen Iraq/Af...

Objectives 1) To identify the rate of short-notice cancelled appointments in a large national sample of persons with multiple sclerosis (MS) and 2) examine the demographic and clinical factors associated with frequent cancellations. Design Retrospective cross-sectional cohort using electronic health records. Setting Veterans Health Administration...

Background and purpose: Many persons with multiple sclerosis (PwMS) experience cognitive impairments, which may affect their ability to engage in physical therapy. There is limited information on how cognitive impairments are associated with PwMS' ability to participate and improve their functional outcomes. This study aimed to assess the relation...

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). A recent randomized controlled trial comparing a fatigue self-management program and a general MS education program found that both programs improved fatigue in participants with MS. Participants were randomized to a self-management program (Fatigue: Take Control,...

Background: Fatigue is one of the most prevalent and impactful symptoms for people with multiple sclerosis (MS). Yet, fatigue is less understood in progressive forms of MS, and few studies have explored the extent to which MS disease course is associated with fatigue. The current study aimed to (1) describe fatigue severity and fatigue interferenc...

Objectives: To examine the biopsychosocial correlates of overall and individual self-management behaviors in persons with multiple sclerosis (PwMS), including demographics, co-occurring medical diagnoses, cognition, personality traits, and psychosocial and physical functioning as variables. Design: Prospective cross-sectional cohort study. Sett...

Background Chronic pain in Veterans is a major problem compounded by comorbid posttraumatic stress disorder (PTSD) and depression. Adopting a transdiagnostic framework to understanding “shared territory” among these diagnoses has the potential to inform our understanding of the underlying cognitive processes and mechanisms that transverse diagnosti...

Objective To describe pain intensity and interference in people with progressive multiple sclerosis (MS), compare these to people with relapsing-remitting MS (RRMS), and identify common and unique factors associated with pain intensity in people with progressive MS and RRMS. Design Observational, cross-sectional analysis using baseline data from a...

Objective To: 1) evaluate the impact of a group-based self-management treatment intervention (VETPALS) on physical and psychosocial functioning (co-primary outcomes) and quality of life (secondary outcome) in individuals with amputation and 2) examine the feasibility and acceptability of the intervention in a large national health care system. Des...

Objective: To examine associations among compensatory cognitive training (CCT), objective cognitive functioning, and self-reported cognitive symptoms. We examined whether change in objective cognitive functioning associated with participation in CCT at 10-week follow-up mediates change in self-reported cognitive symptoms associated with CCT at 15-...

Objective: Psychological treatments for chronic low back pain (CLBP) are effective. However, limited research has investigated their neurophysiological mechanisms. This study examined electroencephalography- (EEG-) assessed brain oscillation changes as potential mechanisms of cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-bas...

Abstract Objective: The purpose of this study was to determine modifiable predictors of intervention adherence in a study of group-based Compensatory Cognitive Training (CCT) for Iraq/Afghanistan War veterans with a history of mild traumatic brain injury (mTBI). Methods: One hundred twenty-three veterans enrolled in a randomized controlled trial...

Objectives Persons with multiple sclerosis (MS) can face a number of potential healthcare-related barriers, for which mobile health (mHealth) technology can be potentially beneficial. This review aimed to understand the frequency, current uses, and potential barriers with mHealth usage among persons with MS. Methods A query string was used to iden...

Purpose of Review Individuals undergoing amputations typically present with comorbid conditions that may adversely impact mortality, mobility, residual limb healing, mood, function, and participation. Understanding how to manage these individuals holistically is essential to optimize function and reduce complications. Recent Findings A review of r...

Background Depression, fatigue, and pain commonly co-occur in multiple sclerosis (MS) and are positively associated with one another. However, it is unclear whether treatment-related improvement in one of these symptoms is associated with improvements in the other two symptoms. Purpose This study examined whether early improvements in depressive s...

Objectives: To (1) describe depressive symptom severity and suicidal ideation (SI) in persons with progressive multiple sclerosis (MS); (2) compare depressive symptom severity and SI in persons with progressive MS and persons with relapsing-remitting MS (RRMS); and (3) identify common and unique risk factors for greater depressive symptom severity...

Objective: Chronic pain rehabilitation warrants sensitivity to unique psychosocial factors, such as trauma history. In Veterans of the United States Armed Forces, military sexual trauma (MST) is a pervasive type of trauma associated with a host of physical and psychological sequelae. A growing literature suggests a relationship between history of...

Objective: The purpose of the current study was to determine modifiable predictors of intervention adherence in a study of group-based Compensatory Cognitive Training (CCT) for Iraq/Afghanistan Veterans with a history of mild traumatic brain injury (mTBI). Methods: One hundred twenty-three Veterans enrolled in a randomized controlled trial of a 10-...

Objective This study examined risk factors in the year prior to suicide in a national sample of Veterans with multiple sclerosis (MS) as well as means of suicide and receipt of mental health services prior to death Design Case control Study. Individuals in the VA MS National Data Repository were linked to the National Death Index Plus to obtain de...

Importance: Multiple sclerosis (MS) is a complex and unpredictable neurologic disease affecting nearly 1 million people in the US. People with MS commonly experience multiple physical and psychological symptoms such as depression, anxiety, stress, fatigue, and pain that impact functioning and quality of life. Subsequently, living with MS requires...

Purpose/objective: The objective of the study was to examine the BIS-BAS model of chronic pain. This model posits that 2 neurophysiological systems-the behavioral inhibition system (BIS) sensitized to and activated by punishment cues and the behavioral activation system (BAS) sensitized to and activated by reward cues-make independent and concurre...

Objectives: To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. Methods: Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypno...

Objective: Aging with physical disability disrupts one’s ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies—tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)—were associated with reduced pain interference and...

Objective To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence, and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions. Design Cross-sectional cohort study using electronic health records. Setting Veterans Health Administration (VA)...

Background: Missed appointments can have negative effects on several facets of healthcare, including disruption of services, worse patient health outcomes, and increased costs. The influence of demographic and clinical factors on missed appointments has been studied in a number of chronic conditions, but not yet in multiple sclerosis (MS). Engagem...

Background Patients undergoing amputation of the lower extremity for the complications of peripheral artery disease and/or diabetes are at risk of treatment failure and the need for reamputation at a higher level. The aim of this study was to develop a patient‐specific reamputation risk prediction model. Methods Patients with incident unilateral t...

Self-management (SM) interventions improve pain, fatigue, and depression in individuals with chronic health conditions. However, little is known about the psychological mechanisms underlying symptom improvement. The current study sought to identify potential mechanisms that mediate the effect of participation in a cognitive-behavioral SM interventi...

Background: Depression is a common comorbid condition among individuals with multiple sclerosis (MS) and is associated with greater overall disease burden and lower quality of life. Numerous clinical trials have supported physical activity interventions versus education, usual care, and attention control conditions for improving depressive symptom...

Background Patients who undergo lower extremity amputation secondary to the complications of diabetes or peripheral artery disease have poor long‐term survival. Providing patients and surgeons with individual‐patient, rather than population, survival estimates provides them with important information to make individualized treatment decisions. Met...

Objectives: Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories. Design: Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postam...

Objective: Much is known about the associations between negative factors and adjustment to chronic pain. However, less is known about how positive factors (e.g., positive affect [PA], resilience) function in relation to disability and mood in individuals with multiple sclerosis (MS). To better understand how positive factors contribute to function...

Objective: To examine the extent to which pain catastrophizing, fatigue catastrophizing, positive affect, and negative affect simultaneously mediated the associations between common symptoms of multiple sclerosis (MS; i.e., pain, fatigue) and impact on daily life, depressive symptoms, and resilience. Method: Participants were community-dwelling adu...

Objective: To examine moderators of treatment effects in a randomized controlled trial comparing a telehealth self-management intervention to a telehealth MS education intervention for fatigue, pain, and mood in adults with multiple sclerosis (MS). Design: Secondary analysis of a single-blind randomized controlled trial. Setting: community. P...

Background Fatigue occurs in 75%–95% of people with multiple sclerosis (MS) and is frequently reported as the most disabling symptom. A multicomponent group program of six weekly 2-hour sessions, Fatigue: Take Control (FTC), was developed from an international MS fatigue management guideline. Objective To determine whether FTC is associated with g...

Multiple sclerosis (MS) is a chronic and progressive central nervous system disease characterized by immune-mediated demyelination and neuronal damage within the brain, spinal cord, and optic nerves. Individuals with MS experience a constellation of symptoms and co-occurring conditions, including sensory problems, cognitive difficulties, weakness,...

Amputation (or limb loss) is the removal of a limb or portion of a limb. It can be the result of many causes including chronic disease (predominantly diabetes mellitus and peripheral vascular disease), infection, trauma, malignancy, or the surgical correction of congenital limb deficiency. Over 90 % of amputations affect lower limbs and over 75 % a...

Objective: To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first lower extremity amputation (LEA). We hypothesized that caregiver-specific support would be associated with lower levels of depressive symptoms and higher levels of life satisfaction, and that...

Objective: To examine the potential moderating effects of mental health symptoms on the efficacy of Compensatory Cognitive Training (CCT) for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Veterans with a history of mild traumatic brain injury (mTBI). Design: Secondary analysis of a randomized controlled...

Objective: This study examined the moderating influence of perceived social support on the prospective relationship between baseline levels of activities of daily living (ADL) and depressive symptoms during the 1st year following amputation. Method: Participants included 73 veterans with new/first unilateral lower extremity amputation due to vas...

Objective: This study examined patterns of social participation among individuals experiencing their first dysvascular lower extremity amputation. We identified the types of social participation valued by this population and explored factors that were associated with individuals' levels of participation and their subjective satisfaction with parti...

Problems with sleep and cognitive impairment are common among people with multiple sclerosis (MS). The present study examined the relationship between self-reported sleep and both objective and perceived cognitive impairment in MS. Data were obtained from the baseline assessment of a multi-centre intervention trial (NCT00841321). Participants were...

Among individuals with multiple sclerosis (MS), mental health comorbidities play a significant role in contributing to secondary disability and detracting from quality of life. This review examines current evidence surrounding three mental health issues of particular relevance to MS: depression, anxiety, and bipolar disorder. We review what is know...

Objective: The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation. Methods: Two prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-201...

Objective This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. Design Prospective cohort study. Setting Four Veteran’s Administration Medical Centers. Subjects Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these,...

Objective: Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Depar...

Objective: This study examined the prevalence and correlates of sexual activity among individuals experiencing their first dysvascular lower extremity amputation. Design: A prospective cohort was recruited from 4 Veterans Affairs Medical Centers. Of 198 potential participants who met inclusion criteria, 113 (57%) agreed to participate within 7 d...

Sleep problems are highly prevalent among individuals with multiple sclerosis (MS); however, the relationship between sleep problems and cognitive dysfunction is poorly understood in this population. In the present study, 163 individuals with MS and depression, fatigue, or pain completed self-report measures of sleep, cognitive dysfunction, and rel...

Objective: The purpose of the study was to evaluate the efficacy of group-based compensatory cognitive training (CCT) for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom(OIF)/Operation New Dawn (OND) Veterans with a history of mild traumatic brain injury. Method: One hundred nineteen OEF/OIF/OND Veterans with history of mild traumatic b...