Talbot Laura A, Brede Emily, Metter E Jeffrey
Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163.
Mil Med. 2017 May;182(5):e1619-e1624. doi: 10.7205/MILMED-D-16-00328.
Service members who have experienced combat trauma with resulting amputation are at risk for compromised quality of life postamputation. Monitoring mental and physical health in amputees returning from the war is of paramount importance. This study examined changes in physical and mental health-related quality of life in service members following traumatic unilateral, transtibial amputation (TTA) during a 12-week period of rehabilitation before and after receiving a prosthesis.
This study is a secondary analysis from a randomized controlled trial (RCT) of military service members starting Military Amputee Rehabilitation Program (MARP) following a traumatic TTA. The study examined change in SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores as two aspects of health-related quality of life. Forty-four injured service members, aged 19 to 46, were recruited into the RCT. Participants were randomized into 12 weeks of MARP plus home neuromuscular electrical stimulation therapy (n = 23) or MARP alone (N = 21) and compared at baseline, 6, and 12 weeks on: SF-36 PCS and MCS scores. Linear mixed models examined time and group differences and their interaction for the MCS and PCS scores. A multivariate mixed model tested whether MCS and PCS scores differed.
For the combined rehabilitation cohort, MCS did not differ over 12 weeks (p = 0.27) with scores at week 0 of M = 56.7 (SD = 11.9) and at week 12 of M = 52.7 (SD = 11.4), similar to healthy controls (age = 25-34, M = 51.0, SD = 7.6). Scores did not differ between treatment groups (p = 0.28) with no group by time interaction (p = 0.34). The MCS significantly declined over time (p = 0.05) after adjustment for covariates. PCS improved over 12 weeks (p < 0.0001) in the total rehabilitation group with scores at week 0 of M = 34.0 (SD = 8.1) to M = 41.8 (SD = 8.4) at week 12, significantly lower than healthy controls (age = 25-34, M = 54.1, SD = 6.6). Scores did not differ between treatment groups (p = 0.89), and there was no group by time interaction (p = 0.34). An interaction between the PCS and MCS was observed such that the PCS improved over time, whereas the MCS did not significantly change (p = 0.0005).
War-injured transtibial amputees are at risk for compromised quality of life during rehabilitation. Self-perceived physical health improved as might be expected from rehabilitation. Self-perceived mental health did not. During rehabilitation, physical healing, psychological adjustment, and lifestyle adaptation are occurring simultaneously. However, more attention may need to be directed toward mental health during rehabilitation.
经历过战斗创伤并因此截肢的军人在截肢后生活质量有受损风险。对战后归来的截肢军人的身心健康进行监测至关重要。本研究调查了军人在接受假肢前后12周的康复期内，单侧创伤性经胫骨截肢（TTA）后与身心健康相关的生活质量变化。
本研究是一项对创伤性TTA后开始军事截肢康复计划（MARP）的军人进行的随机对照试验（RCT）的二次分析。该研究将SF-36身体成分总结（PCS）和心理成分总结（MCS）得分的变化作为与健康相关生活质量的两个方面进行考察。44名年龄在19至46岁之间的受伤军人被纳入RCT。参与者被随机分为接受12周MARP加家庭神经肌肉电刺激治疗组（n = 23）或仅接受MARP组（N = 21），并在基线、第6周和第12周就SF-36 PCS和MCS得分进行比较。线性混合模型检验了时间和组间差异及其对MCS和PCS得分的交互作用。多变量混合模型测试了MCS和PCS得分是否存在差异。
对于综合康复队列，MCS在12周内没有差异（p = 0.27），第0周的得分M = 56.7（标准差 = 11.9），第12周的得分M = 52.7（标准差 = 11.4），与健康对照组（年龄 = 25 - 34岁，M = 51.0，标准差 = 7.6）相似。治疗组之间得分没有差异（p = 0.28），且不存在组间与时间的交互作用（p = 0.34）。在对协变量进行调整后，MCS随时间显著下降（p = 0.05）。在整个康复组中，PCS在12周内有所改善（p < 0.0001），第0周的得分M = 34.0（标准差 = 8.1），到第12周变为M = 41.8（标准差 = 8.4），显著低于健康对照组（年龄 = 25 - 34岁，M = 54.1，标准差 = 6.6）。治疗组之间得分没有差异（p = 0.89），且不存在组间与时间的交互作用（p = 0.34）。观察到PCS和MCS之间存在交互作用，即PCS随时间改善，而MCS没有显著变化（p = 0.0005）。
战争受伤的经胫骨截肢者在康复期间生活质量有受损风险。自我感知的身体健康状况如预期通过康复得到改善。自我感知的心理健康状况则不然。在康复过程中，身体愈合、心理调适和生活方式适应同时发生。然而，在康复期间可能需要更多地关注心理健康。
