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美国退伍军人和因创伤性损伤接受VA住院康复治疗的军人的复原力。复原力的定义是逆境后最小痛苦和稳定功能的调整轨迹。这是一个令人惊讶的常见反应，潜在的令人不安的事件，如战区创伤，失去配偶，或危及生命的事件。然而，人们对创伤性伤害背景下的复原力知之甚少。确定哪些个人素质和情境因素可以预测复原力是很重要的，因为早期发现有风险的个人可以在康复期间采取有针对性的干预措施，以提高复原力，从而改善长期成果。 本研究的主要目的是确定哪些因素预测美国退伍军人和因创伤性损伤接受VA住院康复治疗的人员的复原力。预计几种被称为"弹性因素"的人格特质（例如，乐观）和感知的社会支持将是显着的预测弹性（假设1）。此外，预计那些表现出弹性的人将有更多的社会角色参与，对生活的满意度更高，就业率高于那些没有表现出弹性调整轨迹的人（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其住院早期进行基线测量，并在出院时、基线后1、3、6和12个月进行结局测量。基线变量包括六个弹性因素，感知社会支持，情绪困扰和健康问题的症状，社会和就业活动，历史和人口统计学，以及精神障碍诊断。后续评估变量包括情绪困扰的症状，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，将在12个月随访时管理弹性因素，以检查整个研究期间的变化。 弹性的调整轨迹将通过在研究入组后12个月期间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预测弹性（与非弹性）。为了检验假设2，将使用简单和多变量广义线性模型分析来检查复原力（与非复原力轨迹相比）是否预测更大的社会角色参与（通过克雷格残疾评估和报告技术-简表[CHART-SF]的子量表测量）、更大的生活满意度（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个月期间每周结果的变化。延迟应激反应的发生在这段时间内对于那些接受创伤康复的人来说是最常见的，每周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3年和第4年开展一项旨在培养复原力的干预试点研究，并在第4年与5 - 10名里士满VAMC康复住院患者进行。干预计划将通过前24 - 36个月的数据收集和更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.