Clinical and Rehabilitative Medicine Research Program, Medical Research and Materiel Command, Fort Detrick, MD.
Courage Kenny Research Center, Allina Health, Minneapolis, MN.
Arch Phys Med Rehabil. 2018 Feb;99(2S):S79-S85. doi: 10.1016/j.apmr.2017.04.012. Epub 2017 May 10.
To assess the discriminant validity of the Patrol-Exertion Multitask (PEMT), a novel, multidomain, functional return-to-duty clinical assessment for active duty military personnel.
Measurement development study.
Nonclinical indoor testing facility.
Participants (N=84) were healthy control (HC) service members (SMs; n=51) and military personnel (n=33) with persistent postconcussive symptoms receiving rehabilitation (mild traumatic brain injury [mTBI]).
Not applicable.
Known-groups discriminant validity was evaluated by comparing performance on the PEMT in 2 groups of active duty SMs: HCs and personnel with mTBI residual symptoms. Participant PEMT performance was based on responses in 4 subtasks during a 12-minute patrolling scenario: (1) accuracy in identifying virtual improvised explosive device (IED) markers and responses to scenario-derived questions from a computer-simulated foot patrol; (2) auditory reaction time responses; (3) rating of perceived exertion during stepping; and (4) self-reported visual clarity (ie, gaze stability) during vertical head-in-space translation while stepping.
Significant between-group differences for the PEMT were observed in 2 of 4 performance domains. Postpatrol IED identification task/question responses (P=.179) and rating of perceived exertion (P=.133) did not discriminate between groups. Participant self-report of visual clarity during stepping revealed significant (P<.001) between-group differences. SM reaction time responses to scenario-based auditory cues were significantly delayed in the mTBI group in both the early (P=.013) and late (P=.002) stages of the PEMT.
Findings from this study support the use of a naturalistic, multidomain, complex clinical assessment to discriminate between healthy SMs and personnel with mTBI residual symptoms. Based on this preliminary study, additional research to further refine the PEMT and extend its application to return-to-work outcomes in military and civilian environments is warranted.
评估新型多领域功能重返现役临床评估工具——巡逻-用力多任务（PEMT）的鉴别效度，该工具用于现役军人。
测量开发研究。
非临床室内测试设施。
参与者（N=84）为健康对照组（HC）服务成员（SM；n=51）和军事人员（n=33），患有持续性脑震荡后症状，正在接受康复治疗（轻度创伤性脑损伤[mTBI]）。
不适用。
通过比较两组现役 SM 人员的 PEMT 表现来评估其已知组别的鉴别效度：HC 和有 mTBI 残留症状的人员。参与者的 PEMT 表现基于在 12 分钟巡逻场景的 4 个子任务中的反应：（1）识别虚拟简易爆炸装置（IED）标记的准确性和对来自计算机模拟徒步巡逻的情景衍生问题的反应；（2）听觉反应时间反应；（3）踏步时感知的用力程度；（4）垂直头在空间平移时踏步时自我报告的视觉清晰度（即，凝视稳定性）。
在 4 个表现领域中，PEMT 在 2 个领域存在显著的组间差异。巡逻后 IED 识别任务/问题回答（P=.179）和感知用力程度（P=.133）不能区分两组。参与者在踏步时自我报告的视觉清晰度显示出显著的（P<.001）组间差异。在 PEMT 的早期（P=.013）和晚期（P=.002）阶段，M TBI 组的 SM 对基于情景的听觉线索的反应时间明显延迟。
本研究结果支持使用自然的、多领域的、复杂的临床评估来区分健康的 SM 和有 mTBI 残留症状的人员。基于这项初步研究，需要进一步研究来进一步完善 PEMT 并将其应用于军事和民用环境中的重返工作岗位的结果。
