"Nutritional Functioning" in OEF/OIF/OND Veterans with Polytraumatic Injuries: Developing a New Approach

患有多发性损伤的 OEF/OIF/OND 退伍军人的“营养功能”：开发新方法

• 批准号: 10396980
• 负责人: Diana Brostow
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10396980
• 关键词: Address; Affect; Anxiety; Awareness; Behavior; Belief; Caring; Characteristics; Classification; Clinical; Clinical Trials; Complex; Conflict (Psychology); Country; Data; Development; Dimensions; Economics; Elements; Encapsulated; Enrollment; Environmental Risk Factor; Face; Food; Freedom; Future; Goals; Health; Health Status; Healthcare; Impairment; Income; Individual; Injury; Integrative Medicine; International; Intervention; Interview; Investigation; Knowledge; Learning; Life; Literature; Location; Maintenance; Measurement; Measures; Medical center; Meditation; Mental Depression; Methods; Modality; Modeling; Multiple Trauma; Nutritional; Outcome; Outcome Measure; Perception; Personal Communication; Persons; Physical Capacity; Physical Function; Physical Rehabilitation; Population; Post-Traumatic Stress Disorders; Poverty; Process; Property; Provider; Psychometrics; Psychosocial Factor; Randomized Clinical Trials; Recording of previous events; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Personnel; Restaurants; Risk; Risk Factors; Role; Sampling; Services; Shapes; Social Functioning; Stigmatization; Substance abuse problem; Suggestion; Suicide; Symptoms; Training; Traumatic Brain Injury; Unemployment; Validation; Veterans; Veterans Health Administration; Work; base; care providers; care systems; chronic pain; cognitive capacity; cohort; combat; community reintegration; dexterity; disability; experience; feeding; food insecurity; food security; functional disability; health care model; improved; injured; innovation; internalized stigma; mental function; mindfulness-based stress reduction; novel strategies; nutrition; operation; psychologic; psychological distress; psychosocial; rehabilitation service; rehabilitative care; statistics; substance use; suicidal behavior; therapy design; validation studies

Veterans of the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era are a unique population facing unprecedented obstacles; over 30% struggle with polytrauma, often a combination of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and psychological distress.1,2 The resulting physical and psychosocial disabilities contribute to poor reintegration, characterized by high unemployment,3,4 deeply internalized stigma,5,6 and poor health status.7,8 These disabilities are also significant contributors to food insecurity; being able to access/make use of food in sufficient quantities to meet one’s perceived nutritional needs.9 Research is nascent, but preliminary data suggest that over 25% of OEF/OIF/OND Veterans are food insecure.10 Historically viewed as an economic concern, food insecurity is now understood to be influenced by a range of psychosocial determinants.11,12 Specifically, in the context of rehabilitation and recovery, there is an emerging understanding of nutrition as a multifactorial concept, one which encompasses the physical, psychosocial, and environmental factors that shape one’s relationship with food. Even as the International Classification of Functioning (ICF) prioritizes physical functions, (e.g. self-feeding), researchers have called for rehabilitation services to expand their approach beyond physical mobility or dexterity13,14 Nevertheless, the constructs that comprise food security, heretofore termed “nutritional functioning”, have yet to be operationalized or systematically measured. The VHA’s Polytrauma System of Care provides rehabilitation services to thousands of Veterans.15 In addition, since 2014, the Integrative Health Coordinating Center has led the implementation of the Whole Health model of care,16 which offers integrative health (IH) modalities for polytraumatic injuries.17 Importantly, within the Whole Health model, “Food and Drink” are core elements. Given this, both IH and polytrauma settings are ideal locations for operationalizing and creating a measure of “nutritional functioning,” one that can be used to evaluate injured Veterans’ use of and access to food, identify ‘gaps’ in for intervention, and serve as an outcome for randomized clinical trials. To operationalize nutritional functioning in OEF/OIF/ONF Veterans with polytrauma, and to develop a measure which encapsulates this concept, and can be validated in clinical settings, I propose to: Aim 1: Conduct qualitative interviews to further operationalize the components of nutritional functioning in OEF/OIF/OND Veterans with a history of polytrauma. Use the ICF framework to assess potential additional components, and associated barriers/facilitators to nutritional functioning. Interview VHA providers to assess perceptions regarding nutritional functioning. Aim 2: Develop and pilot a measure of nutritional functioning using components operationalized in Aim 1. Use expert panel input to evaluate content validity and clinical utility, and pilot the measure in a sample of OEF/OIF/OND Veterans with polytrauma. Combine exploratory factor and Rasch model analyses to evaluate dimensionality, scale appropriateness, and item level characteristics to inform measure refinements. Aim 3: Conduct a validation study of the refined measure of nutritional functioning in OEF/OIF/OND Veterans with and without polytrauma enrolled in IH and/or polytrauma rehabilitation services. Evaluate psychometric properties - reliability, validity (construct, known-groups and convergent validity) and Rasch measurement statistics to refine the measure further, and to develop it for future use as an outcome measure of nutritional functioning among those with polytrauma. This proposal addresses the RR&D goal of maximizing functional recovery by focusing on applied physical rehabilitation and psychological recovery. I will accomplish the proposed aims by seeking training in nutritional methods in interdisciplinary settings, measure development, and intervention design.

持久自由行动/伊拉克自由行动/新黎明行动的退伍军人 (OEF/OIF/OND)时代是面临前所未有的障碍的独特人口；超过30%的人正在与 多发性创伤，通常是创伤性脑损伤(TBI)、创伤后应激障碍(PTSD)和 心理痛苦。1、2由此产生的身体和心理社会残疾导致重新融入社会的情况不佳， 特点是高失业率，3，4根深蒂固的耻辱，5，6和糟糕的健康状况。 残疾也是造成粮食不安全的重要因素；能够在#年获得/利用粮食 足够的量来满足一个人感知的营养需求9.研究是新的，但初步的数据 表明超过25%的OEF/OIF/OND退伍军人是粮食不安全的。10历史上被视为经济 令人关切的是，粮食不安全现在被认为受到一系列心理社会决定因素的影响。 具体地说，在康复和康复方面，对营养的理解正在形成，即 一种多因素的概念，包括物理、心理、社会和环境因素 塑造一个人与食物的关系。即使国际功能分类(ICF)被列为优先事项 身体功能(如自我喂养)，研究人员呼吁提供康复服务，以扩大他们的 13、14尽管如此，构成粮食安全的结构， 迄今被称为“营养功能”的指标尚未付诸实施或系统衡量。 VHA的多发创伤护理系统为数千名退伍军人提供康复服务。 此外，自2014年以来，综合健康协调中心牵头实施了 保健模式，16为多创伤性损伤提供综合保健(IH)模式。 在整个健康模式中，“食物和饮料”是核心要素。有鉴于此，IH和多发性创伤 环境是操作和创建一种“营养功能”测量的理想场所，这种测量方法可以 用于评估受伤退伍军人使用和获得食物的情况，找出需要干预的“差距”，并作为 这是随机临床试验的结果。 目的：在有多发伤的OEF/OIF/ONF退伍军人中实施营养功能，并制定 包含这一概念并可在临床环境中验证的措施，我建议： 目标1：进行定性访谈，以进一步实施营养功能的组成部分 OEF/OIF/OND退伍军人有多处创伤病史。使用ICF框架评估潜在的其他 营养成分，以及相关的营养功能障碍/促进剂。约谈VHA提供商以评估 对营养功能的看法。 目标2：使用目标1中操作的组件开发和试行营养功能的衡量标准。使用 评估内容有效性和临床实用性的专家小组输入，并在以下样本中试行该措施 OEF/OIF/OND多发伤退伍军人。结合探索性因素和Rasch模型分析进行评估 维度、规模适当性和项目级特征，以提供测量改进的信息。 目的3：对OEF/OIF/OND退伍军人的营养功能改进措施进行验证研究 在IH和/或多处创伤康复服务中登记有或没有多处创伤。评估心理测量学 属性--信度、效度(结构、已知群体和收敛效度)和Rasch测量 统计数据，以进一步完善这一衡量标准，并将其发展为未来作为营养结果衡量标准的使用 在多发性创伤患者中发挥作用。 该提案旨在通过关注应用程序实现最大限度地提高功能恢复的RR&D目标 身体康复和心理康复。我将通过寻求培训来实现所提出的目标 在跨学科环境下的营养方法、测量发展和干预设计。