Long-term health and quality of life experiences of Vietnam veterans with combat-related limb loss

Foote, C.E.; Kinnon, Joyce Mac; Robbins, Christopher; Pessagno, Regina; Portner, Matthew D.

doi:10.1007/s11136-015-1029-0

Cited by 30 publications

(31 citation statements)

References 32 publications

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“…The results of this study indicate that across the three states, good current mental health was moderately to highly-related to health conditions and activity limitations after controlling for health conditions, alcohol use, marital status, employment status, metropolitan status, age, ethnicity/race, and gender. Our findings are consistent with past research indicating relations between veteran mental health and physical health issues in veterans using veteran services [2,[5][6][7][8] and between activity limitations and depressive symptoms in older adults [10,11]. Because not all veterans use Veteran Affair Services [12], it is important that civilian practitioners know about the relations among mental health, physical health, and activity limitations in this target population.…”

Section: Discussionsupporting

confidence: 90%

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Assessing the Relationship between Current Mental Health, Health Conditions,and Activity Limitations in Veterans Aged 25 and Older in the General Population

Knickerbocker¹,

McElroy²,

Hartos³

2017

J Prev Med

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Purpose: Many veterans face difficulties related to physical and mental health issues, but little is known about how these are related within veterans in the general population. The purpose of this study was to examine the association between current mental health, health problems, and activity limitations in population-based samples of veterans aged 25 years and older. Methods:This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for veterans aged 25 and older from Oklahoma, Virginia, and Washington. Multiple logistic regression analysis was used to assess the relationship between current mental health, health conditions, and activity limitations after controlling alcohol use and demographic variables.Results: Across states, most veterans aged 25 and older reported good current mental health (77-81%), about half reported 3 or more health conditions (40-54%), and about one-fourth reported activity limitations (17-28%). After controlling for alcohol use and demographic factors, good current mental health was inversely related to health conditions and activity limitations in all three states with moderate to high effect sizes. Conclusion:The results of this study indicated that current mental health among veterans aged 25 years and older in general populations is significantly related to health conditions, activity limitations, and gender. Because of moderate to high relations, primary care practitioners should screen for mental health, health conditions, and activity limitations if a veteran, especially a female veteran, presents with any of these, and then educate, treat, and provide referral services as comorbid conditions versus separate issues.

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Section: Discussionsupporting

confidence: 90%

“…For example, veterans with physical health issues [8] have increased rates of depression [2] and anxiety [5]. In addition, the coexistence of physical and mental disorders further increases the incidence of activity limitations [5].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Relationship between Current Mental Health, Health Conditions,and Activity Limitations in Veterans Aged 25 and Older in the General Population

Knickerbocker¹,

McElroy²,

Hartos³

2017

J Prev Med

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“…27 While cross-sectional figures indicate that chronic LBP affects up to 33% of adults in the general population, the incidence in persons with LL who report LBP secondary to trauma is nearly double (52-76%). [28][29][30][31] Along with this significantly higher prevalence, nearly 50% of persons with LL have reported LBP as ''more bothersome'' than either residual or phantom limb pain and as having a significant reduction in overall QoL metrics. 28,30,32 While the exact etiology of LBP within this population is unclear, there is a growing body of evidence suggesting that altered lumbopelvic mechanics during the (repetitive) gait cycle likely influences such risk.…”

Section: Low Back Painmentioning

confidence: 99%

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

Butowicz

Dearth

Hendershot

2017

Advances in Wound Care

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Significance: Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of service members (SMs) following combat trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). Beyond the acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility, traumatic LL and LS are associated with several debilitating longer term secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], and cardiovascular disease [CVD]) that can adversely impact physical function and quality of life. Recent Advances: Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with LL and salvage, which are purported risk factors for the development of longer term secondary musculoskeletal conditions and may limit functional outcomes and/or concomitantly impact cardiovascular health. Critical Issues: The increased prevalence of and risk for LBP, OA, and CVD among the relatively young cohort of SMs with LL and LS significantly impact physiological and psychological well-being, particularly over the next several decades of their lives. Future Directions: Longitudinal studies are needed to characterize the onset, progression, and recurrence of health conditions secondary to LL and salvage. While not a focus of the current review, detailed characterization of physiological biomarkers throughout the rehabilitation process may provide additional insight into the current understanding of disease processes of the musculoskeletal and cardiovascular systems.Keywords: amputation, biomechanics, cardiovascular disease, limb salvage, low back pain, osteoarthritis SCOPE AND SIGNIFICANCEExtremity trauma, including limb loss (LL) and limb salvage (LS), is commonly associated with an elevated risk for secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], cardiovascular disease [CVD]) that can significantly limit physical function, reduce quality of life (QoL), and life expectancy. This review provides an extensive commentary regarding resultant secondary health effects of extremity trauma in service members (SMs), with a particular focus on functional outcomes and quality of movement. TRANSLATIONAL RELEVANCEPhysiologic biomarkers provide an opportunity to enhance translation in future work to examine the pathophysiology of the secondary health conditions associated with traumatic LL from a basic science perspective. While this approach is yet to be fully explored and thus was not a primary focus of this review, such biomarkers may augment traditional analyses and support more comprehensive risk characterization, thereby allowing clinicians and researchers to better mitigate disease onset or progression. CLINICAL RELEVANCEThe increased prevalence of secondary health effects following traumatic extremity injuries places a...

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“…Most studies (15 of the 21) were surveys of various long-term physical and psychological outcomes, three used qualitative or mixed methods (Foote et al . 2015; Machin and Williams 1998; Meyers 2014) and three (Blough et al . 2010; Edwards et al .…”

Section: Resultsmentioning

confidence: 99%

Ageing, limb-loss and military veterans: a systematic review of the literature

Caddick

Cullen²,

Clarke

et al. 2018

Ageing and Society

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The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or healthcare requirements in veterans were included. The search process revealed  papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psychosocial adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans' families calls for further research to address these important issues.

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Long-term health and quality of life experiences of Vietnam veterans with combat-related limb loss

Abstract: The prevalence of these health issues and the adverse effects of some of these on QOL underscore the importance of effective rehabilitation over the life course, especially including better mental health care and pain management.

Cited by 30 publications

References 32 publications

Assessing the Relationship between Current Mental Health, Health Conditions,and Activity Limitations in Veterans Aged 25 and Older in the General Population

Assessing the Relationship between Current Mental Health, Health Conditions,and Activity Limitations in Veterans Aged 25 and Older in the General Population

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

Ageing, limb-loss and military veterans: a systematic review of the literature

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