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: 8838193
• 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/8838193
• 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; Injury; 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; United States National Institutes of Health; Update; Veterans; biological adaptation to stress; demographics; emotional distress; fitness; follow-up; handicapping condition; improved; injured; intervention program; mental disorder diagnosis; optimism; programs; 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） 这项研究的目的是确定哪些因素可以预测美国军事退伍军人和维持人的韧性。韧性是由逆境后的最小遇险和稳定功能的调整轨迹定义的。这是对潜在令人不安的事件（例如Warzone创伤，失去配偶或危及生命的事件）的一个令人惊讶的共同反应。但是，在创伤性损伤的背景下，关于弹性的了解鲜为人知。确定哪些个人质量和情况因素可以预测弹性很重要，因为早期危险人群可以在康复过程中导致有针对性的干预措施，以提高弹性并从而长期结局。 这项研究的主要目的是确定哪些因素可以预测接受VA住院治疗康复的美国军事退伍军人和人员的韧性。预计几种人格特征称为“弹性因素”（例如乐观主义）和感知的社会支持将是弹性的重要预测指标（假设1）。同样，比那些没有证明弹性调整轨迹的人，预计那些表现出韧性的人将具有更多的社会角色参与，对生活的满意度和更高的就业率（假设2）。 一百六十七个里士满·弗吉尼亚州医疗中心康复住院患者将从VA Polytrauma康复中心，脊髓损伤和疾病诊所招募。接受住院康复的退伍军人将在住院早期进行基线措施，并在出院后1、3、6和12个月时进行结果措施。基线变量包括六个弹性因素，感知到的社会支持，情绪困扰和健康问题的症状，社会和就业活动，历史和人口统计学以及精神障碍诊断。后续评估变量包括情绪困扰，感知的社会支持，健康和治疗的变化，精神障碍诊断，对生活和就业的满意度。此外，将在12个月的随访中进行弹性因素，以检查整个研究期间的变化。 在研究入学后的12个月内，观察到的低或正常焦虑和抑郁以及正常范围的正常影响的模式将定义弹性的调整轨迹。为了检验假设1，将使用双变量和多元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的一般线性模型分析来检查弹性（与非弹性轨迹相对于非弹性轨迹）是否可以预测更大的社会角色参与（通过CRAIG障碍评估和报告技术量表的分量表来衡量[图表 - SF] [图表SF]），对生活量表的满意度更高（满意度）和就业。 将要求参与者的一部分（n = 20）参加一项试点研究，以检查远程医疗方法的可行性和效率，以评估基本结束后3至6个月的预后变化。对于那些接受创伤性伤害康复的人来说，在这段时间内最常见的是，压力反应的发作最为常见，每周监测将改善我们对这一过程的理解。最后，一项旨在促进弹性的干预试验研究将在CDA-2资助期的第3和4年内开发，并在4年级进行了5-10届里士满VAMC康复住院医师的工作。干预计划将通过最初的24-36个月的数据收集和更新的文献综述来告知。