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
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.
aCenter for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN⁎
bPhysical Medicine and Rehabilitation, VA Medical Center, Richmond, VA⁎
cPhysical Medicine and Rehabilitation, VA Medical Center, Richmond, VA⁎
dCenter for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN⁎
ePhysical Medicine and Rehabilitation, VA Medical Center, Minneapolis, MN⁎
fPhysical Medicine and Rehabilitation, VA Medical Center, Tampa, FL⁎
gPhysical Medicine and Rehabilitation, VA Medical Center, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130⁎
Address correspondence to: H.L.L.
Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org
The opinions expressed in this paper do not necessarily represent those of the Department of Veterans Affairs.
This research was supported by VA Health Service Research & Development (HSR&D) grant RRP 06-150.
ABSTRACT