Rehabilitation Needs of Combat-Injured Service Members Admitted to the VA Polytrauma Rehabilitation Centers: The Role of PM&R in the Care of Wounded Warriors

Sayer, Nina A.; Cifu, David X.; McNamee, Shane; Chiros, Christine E.; Sigford, Barbara J.; Scott, Steve; Lew, Henry L.

doi:10.1016/j.pmrj.2008.10.003

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Volume 1, Issue 1 , Pages 23-28, January 2009

Rehabilitation Needs of Combat-Injured Service Members Admitted to the VA Polytrauma Rehabilitation Centers: The Role of PM&R in the Care of Wounded Warriors

Nina A. Sayer, PhD
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN^⁎
David X. Cifu, MD
- Physical Medicine and Rehabilitation, VA Medical Center, Richmond, VA^⁎
Shane McNamee, MD
- Physical Medicine and Rehabilitation, VA Medical Center, Richmond, VA^⁎
Christine E. Chiros, PhD
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN^⁎
Barbara J. Sigford, MD, PhD
- Physical Medicine and Rehabilitation, VA Medical Center, Minneapolis, MN^⁎
Steve Scott, MD
- Physical Medicine and Rehabilitation, VA Medical Center, Tampa, FL^⁎
Henry L. Lew, MD, PhD
- Physical Medicine and Rehabilitation, VA Medical Center, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130^⁎
- Address correspondence to: H.L.L.

Received 27 September 2008; accepted 16 October 2008.

Objective

To describe the rehabilitation course of combat-injured service members who sustained polytraumatic injuries during the current wars in and around Iraq and Afghanistan.

Design

Retrospective descriptive analysis.

Setting

Department of Veterans Administration Polytrauma Rehabilitation Centers (PRCs).

Participants

One hundred eighty-eight consecutive, acutely combat-injured service members suffering polytraumatic injuries requiring inpatient rehabilitation and being treated at PRCs between October 2001 and January 2006.

Interventions

Not applicable.

Main Outcome Measures

Medications prescribed, devices used, injuries and impairment information, and consultative services.

Results

Ninety-three percent of the patients had sustained a traumatic brain injury (TBI) and more than half of these were incurred secondary to blast explosions. Over half of the patients had infections or surgeries prior to PRC admission that required continued medical attention during their stay. Pain and mental health issues were present in 100% and 39%, respectively, of all patients admitted and added complexity to the brain injury rehabilitation process. Common treatment needs included cognitive-behavioral interventions, pain care, assistive devices, mental health interventions for both patients and their families, and specialty consultations, in particular to ophthalmology, otolaryngology, and neurology.

Conclusions

Combat-injured polytrauma patients have complex rehabilitation needs that require a high level of specialized training and skill. Physical medicine and rehabilitation specialists treating war injured service members need a high level of expertise in assessment and treatment of co-occurring pain, TBI, and stress disorders. Physiatrists are playing an important role in providing and coordinating the rehabilitation care for individuals with significant polytraumatic war injuries from the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts.