Resilience and Adjustment after VA Inpatient Rehabilitation for Traumatic Injury

退伍军人管理局创伤性住院患者康复后的恢复能力和调整

• 批准号: 9052610
• 负责人: Scott D. McDonald
• 金额: --
• 依托单位: VA VETERANS ADMINISTRATION HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9052610
• 关键词: Address; Affect; Anxiety; Clinic; Critiques; Data Collection; Development; Disabled Persons; Disease; Distress; Early Diagnosis; Early Intervention; Employment; Enrollment; Event; Exhibits; Fostering; Funding; Health; Health Care Costs; Hospitalization; Human Resources; Individual; Inpatients; Intervention; Joints; Lead; Life; Linear Models; Logistic Regressions; Measures; Medical center; Mental Depression; Military Personnel; Monitor; Normal Range; Outcome; Outcome Measure; Participant; Patients; Pattern; Personality Traits; Pilot Projects; Process; Psychological adjustment; Published Comment; Recording of previous events; Recruitment Activity; Regression Analysis; Rehabilitation Centers; Rehabilitation therapy; Reporting; Research; Review Literature; Risk; Social Problems; Social Role-Participation; Social support; Soldier; Spinal cord injury; Spouses; Symptoms; Techniques; Testing; Training Programs; Trauma; Traumatic injury; United States National Institutes of Health; Update; Veterans; biological adaptation to stress; demographics; emotional distress; exercise program; follow-up; handicapping condition; improved; injured; intervention program; mental disorder diagnosis; optimism; research and development; resilience; response; satisfaction; telehealth; working group

DESCRIPTION (provided by applicant) The purpose of this study is to determine what factors predict resilience among U.S. military veterans and servicemembers receiving VA inpatient rehabilitation for traumatic injuries. Resilience is defined by an adjustment trajectory of minimal distress and stable functioning following adversity. It is a surprisingly common response to potentially disturbing events such as warzone trauma, the loss of a spouse, or a life-threatening event. However, relatively little is known about resilience in the context of traumatic injury. Determining what personal qualities and situational factors predict resilience is important, as early detection of at-risk individuals can lead to targeted interventions during rehabilitation to improve resilience and thus long-term outcomes. The primary aim of this study is to determine what factors predict resilience for U.S. military veterans and personnel receiving VA inpatient rehabilitation for traumatic injuries. It is expected that several personality traits called "resiliency factors" (e.g., optimism) and perceived social support will be significant predictors of resilience (Hypothesis 1). Also, it is expected that those exhibiting resilience will have more social role participation, greater satisfaction with life, and higher rates of employment than those who do not demonstrate a resilience adjustment trajectory (Hypothesis 2). One-hundred and sixty-seven Richmond VA Medical Center rehabilitation inpatients will be recruited from the VA Polytrauma Rehabilitation Center and the Spinal Cord Injury and Disorders Clinic. Veterans receiving inpatient rehabilitation will be administered baseline measures early in their hospitalization and outcome measures will be administered at discharge, 1, 3, 6, and 12 month post- baseline. Baseline variables include six resiliency factors, perceived social support, symptoms of emotional distress and health problems, social and employment activities, history and demographics, and mental disorder diagnoses. Follow-up assessment variables include symptoms of emotional distress, perceived social support, changes in health and treatment, mental disorder diagnoses, satisfaction with life, and employment. In addition, resiliency factors will be administered at 12 month follow-up to examine changes across the study period. An adjustment trajectory of resilience will be defined by a pattern of observed low or normal- range anxiety and depression and normal-to-high range positive affect during the 12 months following study enrollment. To test Hypothesis 1, bivariate and multivariate logistic regression analyses will be used to examine what factors predict resilience (vs. non-resilience). To test Hypothesis 2, simple and multivariate generalized linear model analyses will be used to examine whether resilience (vs. non- resilience trajectory) predicts greater social role participation (as measured by subscales of the Craig Handicap Assessment and Reporting Technique-Short Form [CHART-SF]), greater satisfaction with life (Satisfaction with Life Scale), and employment. A subset of participants (n = 20) will be asked to participate in a pilot study to examine the feasibility and efficiency of a telehealth approach to assess weekly changes in outcomes between 3 and 6 months post-baseline. Onset of a delayed stress response is most common during this timeframe for those receiving rehabilitation for traumatic injuries, and weekly monitoring will improve our understanding of this process. Finally, an intervention pilot study aiming to foster resilience will be developed in Years 3 and 4 of the CDA-2 funding period and conducted in Year 4 with 5-10 Richmond VAMC rehabilitation inpatients. The intervention program will be informed by the first 24-36 months of data collection and an updated literature review.

描述（由申请人提供） 本研究的目的是确定哪些因素可以预测接受退伍军人管理局创伤性损伤住院康复治疗的美国退伍军人和现役军人的复原力。复原力的定义是逆境后最小痛苦和稳定功能的调整轨迹。这是对战区创伤、失去配偶或危及生命的事件等潜在令人不安的事件的常见反应，令人惊讶。然而，人们对创伤性损伤情况下的恢复能力知之甚少。确定哪些个人品质和情境因素可以预测复原力非常重要，因为及早发现高危个体可以在康复过程中采取有针对性的干预措施，从而提高复原力，从而获得长期结果。 本研究的主要目的是确定哪些因素可以预测美国退伍军人和接受退伍军人管理局创伤性损伤住院康复治疗的人员的恢复能力。预计被称为“弹性因素”（例如乐观）的几种人格特征和感知的社会支持将是弹性的重要预测因素（假设1）。此外，预计那些表现出复原力的人将比那些没有表现出复原力调整轨迹的人有更多的社会角色参与、更高的生活满意度和更高的就业率（假设2）。 将从 VA 多发伤康复中心和脊髓损伤和疾病诊所招募 167 名里士满 VA 医疗中心康复住院患者。接受住院康复治疗的退伍军人将在住院初期进行基线测量，并在出院时、基线后 1、3、6 和 12 个月进行结果测量。基线变量包括六个弹性因素、感知的社会支持、情绪困扰和健康问题的症状、社会和就业活动、历史和人口统计以及精神障碍诊断。后续评估变量包括情绪困扰症状、感知的社会支持、健康和治疗的变化、精神障碍诊断、生活满意度和就业。此外，弹性因素将在 12 个月的随访中进行管理，以检查整个研究期间的变化。 复原力的调整轨迹将由研究入组后 12 个月内观察到的低或正常范围的焦虑和抑郁以及正常到高范围的积极影响的模式来定义。为了检验假设 1，将使用双变量和多变量逻辑回归分析来检查哪些因素可以预测弹性（与非弹性）。为了检验假设 2，将使用简单和多元广义线性模型分析来检验弹性（相对于非弹性轨迹）是否预测更大的社会角色参与（通过克雷格障碍评估和报告技术简表的子量表来衡量[图表] -SF]）、更高的生活满意度（生活满意度量表）和就业。 将要求一部分参与者 (n = 20) 参加一项试点研究，以检验远程医疗方法的可行性和效率，以评估基线后 3 至 6 个月内每周结果的变化。对于那些接受外伤康复的人来说，延迟应激反应的出现在这段时间内最为常见，每周监测将提高我们对这一过程的理解。最后，一项旨在增强复原力的干预试点研究将在 CDA-2 资助期的第 3 年和第 4 年进行，并在第 4 年对 5-10 名 Richmond VAMC 康复住院患者进行。干预计划将根据前 24-36 个月的数据收集和更新的文献综述来制定。