Resilience and Adjustment after VA Inpatient Rehabilitation for Traumatic Injury

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因创伤而接受退伍军人康复治疗的美国退伍军人和军人的复原力。复原力的定义是在逆境之后最小的痛苦和稳定的功能的调整轨迹。这是一种令人惊讶的常见反应，对潜在令人不安的事件，如战区创伤、失去配偶或危及生命的事件。然而，人们对创伤性损伤背景下的复原力知之甚少。确定哪些个人素质和情景因素预测复原力是重要的，因为早期发现高危个人可以导致在康复期间进行有针对性的干预，以提高复原力，从而提高长期结果。这项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因创伤接受退伍军人管理局住院康复治疗的人员的复原力。预期被称为“复原力因素”(例如，乐观主义)和感知到的社会支持的几种人格特征将是复原力的显著预测因素(假设1)。此外，预计表现出韧性的人将比那些没有表现出韧性调整轨迹的人有更多的社会角色参与，对生活更高的满意度，以及更高的就业率(假设2)。167名里士满退伍军人医疗中心康复住院患者将从退伍军人管理局多重创伤康复中心和脊髓损伤和疾病诊所招募。接受住院康复治疗的退伍军人将在住院早期实施基线评估，并在出院时、基线后1、3、6和12个月实施结果评估。基线变量包括六个复原力因素、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、感受到的社会支持、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个月的随访中实施，以检查整个研究期间的变化。弹性的调整轨迹将由在研究登记后12个月内观察到的低范围或正常范围的焦虑和抑郁以及从正常范围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Logistic回归分析来检验哪些因素预测弹性(与非弹性相比)。为了验证假设2，简单和多变量的广义线性模型分析将被用来检验弹性(与非弹性轨迹)是否预示着更大的社会角色参与(通过克雷格残疾评估和报告技术的子量表[图表-SF]来衡量)、对生活(生活满意度量表)和就业的更大满意度。一组参与者(n=20)将被要求参加一项试点研究，以检查远程保健方法的可行性和效率，以评估基线后3至6个月期间结果的每周变化。在这段时间内，对于那些因创伤而接受康复的人来说，延迟的应激反应是最常见的，每周的监测将提高我们对这一过程的理解。最后，将在CDA-2资助期的第三年和第四年开展旨在培养复原力的干预试点研究，并在第四年对5-10名里士满VAMC康复住院患者进行研究。干预计划将通过最初24-36个月的数据收集和最新的文献综述来了解。

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.