TY - JOUR
T1 - Persistent Pain, Physical Dysfunction, and Decreased Quality of Life After Combat Extremity Vascular Trauma
AU - Haney, Lauren J.
AU - Pugh, Mary Jo V.
AU - Copeland, Laurel A.
AU - Wang, Chen Pin
AU - MacCarthy, Daniel J.
AU - Amuan, Megan E.
AU - Shireman, Paula K.
N1 - Funding Information:
The authors acknowledge the Department of Defense Trauma Registry (DoDTR) for providing data for this study and the respondents who gave their time to complete the survey measures. The authors acknowledge the valuable contributions of Kathleen Franklin, RN, and Natalie Rohde, MA, in data abstraction and survey support and Deeksha Sharma, MS, for performing the Kaplan-Meier analyses. Funding: This work was supported by the Veterans Health Administration (HX001304/IIR 13?029). The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2020
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Background: Combat-related extremity vascular injuries (EVI) have long-lasting impact on Iraq/Afghanistan veterans. The purpose of this study is to describe long-term functional outcomes in veterans with EVI using survey measures and identify modifiable factors that may be improved to reduce chronic pain and injury-related dysfunction. Methods: Veterans with upper and lower EVI undergoing an initial limb salvage attempt were identified using the Department of Defense Trauma Registry and validated with chart abstraction. Surveys measured pain; Short Musculoskeletal Function Assessment (SMFA) for self-reported bother and dysfunction; and Veterans RAND 12-Item Health Survey (VR-12) physical and mental component scores (PCS; MCS) for quality of life, depression, post-traumatic stress disorder, and the potentially modifiable factors of reintegration into civilian life, resilient coping, resilience, and family functioning. Results: Eighty-one patients responded with an average time since injury of 129 months (SD: 31; range 67–180 months). Mechanism of injury included 64% explosions and 31% gunshot wounds; 16% of the respondents were diagnosed with moderate/severe/penetrating traumatic brain injury. Limb salvage rates were 100% and 77% for upper and lower extremities, respectively (P = 0.004). Respondents screened positive for probable depression (55%) and post-traumatic stress disorder (51%). Compared with population norms, SMFA bother and dysfunction indices were higher (worse), MCS was lower (worse), and PCS was similar. The multivariable models adjusted for age, marital status and pain. The higher SMFA is part of the results of the multivariable models. MCS decreased with difficulty reintegrating into civilian life and was positively correlated with increased resilience and resilient coping. SMFA scores were greater for patients with high pain intensity and increased 6–11 points per point increase in difficulty with civilian-life reintegration. SMFA dysfunction was associated with better family functioning. Conclusions: EVI results in significant long-term disability with lasting deficits in physical function, frequent depressive symptoms, and below average self-reported quality of life. Strengthening modifiable factors including resiliency and resilient coping, and providing ongoing assistance to improve reintegration into civilian life, may ameliorate the functional disabilities and chronic pain experienced by veterans with EVI.
AB - Background: Combat-related extremity vascular injuries (EVI) have long-lasting impact on Iraq/Afghanistan veterans. The purpose of this study is to describe long-term functional outcomes in veterans with EVI using survey measures and identify modifiable factors that may be improved to reduce chronic pain and injury-related dysfunction. Methods: Veterans with upper and lower EVI undergoing an initial limb salvage attempt were identified using the Department of Defense Trauma Registry and validated with chart abstraction. Surveys measured pain; Short Musculoskeletal Function Assessment (SMFA) for self-reported bother and dysfunction; and Veterans RAND 12-Item Health Survey (VR-12) physical and mental component scores (PCS; MCS) for quality of life, depression, post-traumatic stress disorder, and the potentially modifiable factors of reintegration into civilian life, resilient coping, resilience, and family functioning. Results: Eighty-one patients responded with an average time since injury of 129 months (SD: 31; range 67–180 months). Mechanism of injury included 64% explosions and 31% gunshot wounds; 16% of the respondents were diagnosed with moderate/severe/penetrating traumatic brain injury. Limb salvage rates were 100% and 77% for upper and lower extremities, respectively (P = 0.004). Respondents screened positive for probable depression (55%) and post-traumatic stress disorder (51%). Compared with population norms, SMFA bother and dysfunction indices were higher (worse), MCS was lower (worse), and PCS was similar. The multivariable models adjusted for age, marital status and pain. The higher SMFA is part of the results of the multivariable models. MCS decreased with difficulty reintegrating into civilian life and was positively correlated with increased resilience and resilient coping. SMFA scores were greater for patients with high pain intensity and increased 6–11 points per point increase in difficulty with civilian-life reintegration. SMFA dysfunction was associated with better family functioning. Conclusions: EVI results in significant long-term disability with lasting deficits in physical function, frequent depressive symptoms, and below average self-reported quality of life. Strengthening modifiable factors including resiliency and resilient coping, and providing ongoing assistance to improve reintegration into civilian life, may ameliorate the functional disabilities and chronic pain experienced by veterans with EVI.
UR - http://www.scopus.com/inward/record.url?scp=85091690772&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091690772&partnerID=8YFLogxK
U2 - 10.1016/j.avsg.2020.08.104
DO - 10.1016/j.avsg.2020.08.104
M3 - Article
C2 - 32890646
AN - SCOPUS:85091690772
VL - 71
SP - 167
EP - 180
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
SN - 0890-5096
ER -