Understanding Participation in Veterans with Amputations

 描述（由申请人提供）： 截肢退伍军人是一个重要的人口面临着相当大的身体，社会和情感的挑战，可能会阻碍他们重新融入社区。我们将重返社区定义为一系列生活角色的活动和参与，包括与配偶/重要他人的关系;养育;教育;工作;社会;休闲;精神/宗教，公民;自我照顾;家庭生活;和经济生活。虽然大多数截肢的退伍军人在这些地区享有充实和富有成效的生活，但研究表明，这一人群中心理困扰和角色限制的比例有所增加。医疗器械（即，设计成最大化平衡和移动性的假体）和心理社会干预（即，认知行为疗法）提供了进一步加强重返社区的机会。不幸的是，缺乏截肢退伍军人重返社区的系统数据，包括相关的物理和环境因素，阻碍了我们最有效地设计和瞄准未来设备和干预措施的能力。项目目标该项目是一组在重返社会、定性（调查）方法和定量方法方面拥有专业知识的心理学家临床研究人员与一组在截肢、假肢和移动健康技术方面拥有专业知识的成熟生物医学工程师之间的新型合作。这项合作的总体目标是生成有关截肢退伍军人重返社区结果的系统信息，以促进旨在改善重返社会结果的干预措施和技术的发展或完善。具体目标1：确定重返社区及其相关的物质（即，截肢和医学并发症）和背景（即，心理、环境和医疗器械）因素。具体目标二：深入了解退伍军人重返社区的经验，并发现截肢退伍军人重返社区的潜在障碍和促进因素。项目方法这是一个混合方法的调查退伍军人与主要下肢截肢谁收到了明尼阿波利斯VA地区截肢中心（RAC）的服务。目标1将利用通过RAC数据库确定的425名截肢退伍军人的邮寄调查。该调查将采用经验证的社会和社区参与措施评估重返社区的情况，这些措施在残疾人和一般人口样本中得到规范。它还将包括重返社会的重要相关因素，包括心理措施（例如，抑郁、焦虑、身体意象），身体（例如，假体使用，疼痛）和环境（例如，社会支持）因素。多元线性回归分析将用于检查每个变量对人口统计学因素的独立贡献。目标2将解决使用数据从定性访谈与退伍军人（n=24）的一个子集，不同层次的服务时代分层的社区重返社会。深入访谈将探讨退伍军人对重返社会的看法;援助和支持;感知的障碍和促进者;感知的医疗和心理社会服务需求;以及对重返社会相关医疗技术的兴趣和使用。一个快速的周转定性分析方法将被用来提取和总结关键主题。结果将用于为新技术的开发提供信息（例如，假肢、移动健康应用程序）以及旨在支持和加强退伍军人重返社区的心理社会干预措施。

 DESCRIPTION (provided by applicant): Project Background Veterans with amputation are an important population facing considerable physical, social, and emotional challenges that can impede their reintegration into the community. We define community reintegration as activities and participation across a range of life roles including Relationship with spouse/significant other; Parenting; Education; Work; Social; Leisure; Spiritual/Religious, Civic; Self Care; Domestic Life; and Economic Life. While the majority of Veterans with amputation enjoy full and productive lives in these areas, studies have documented increased rates of psychological distress and role limitation within this population. Medical devices (i.e., prostheses designed to maximize balance and mobility) and psychosocial interventions (i.e., cognitive behavioral therapies) offer opportunities to further enhance community reintegration. Unfortunately, a lack of systematic data on the community reintegration of Veterans with amputation, including associated physical and contextual factors, hampers our ability to most effectively design and target future devices and interventions. Project Objectives This project is a novel collaboration between a group of psychologist clinician investigators with expertise in reintegration, qualitative (survey) methodology and quantitative methods and an accomplished group of biomedical engineers with expertise in amputation, prostheses, and mHealth technology. The overall goal of this collaboration is to generate systematic information about the community reintegration outcomes of Veterans with amputation needed to advance the development or refinement of interventions and technologies aimed at improving reintegration outcomes. The specific aims for this pilot (SPiRE) proposal are: Specific Aim 1: To characterize community reintegration and its associated physical (i.e., amputation and medical comorbidity) and contextual (i.e., psychological, environmental, and medical device) factors. Specific Aim 2: To obtain a deeper understanding of Veterans' experience of community reintegration and discover potential barriers and facilitators of community reintegration among Veterans with amputation. Project Methods This is a mixed-methods investigation of Veterans with major lower limb amputation who have received services from the Minneapolis VA Regional Amputation Center (RAC). Aim 1 will utilize a mailed survey of 425 Veterans with amputation identified through a RAC database. The survey will assess community reintegration with validated measures of social and community participation that are normed within disability and general population samples. It will also include important correlates of reintegration including measures of psychological (e.g., depression, anxiety, body image), physical (e.g., prosthetic use, pain) and environmental (e.g., social support) factors related to reintegration. Multiple linear regression analyses will be used to examine the independent contribution of each variable over and above demographic factors. Aim 2 will be addressed using data from qualitative interviews with a subset of Veterans (n=24) with varying levels of community reintegration stratified by service era. In-depth interviews will explore Veterans' perspectives on reintegration; aids and supports; perceived barriers and facilitators; perceived needs for medical and psychosocial services; and interest in and use of medical technologies related to reintegration. A rapid turn- around qualitative analytic approach will be used to extrac and summarize key themes. Results will be used to inform the development of new technological (e.g., prostheses, mHealth applications) and psychosocial interventions aimed at supporting and enhancing Veteran community reintegration.