Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
Leidos, Inc, San Diego, CA, USA.
Qual Life Res. 2021 Sep;30(9):2531-2540. doi: 10.1007/s11136-021-02836-y. Epub 2021 Apr 22.
The purpose of this study was to identify symptom profiles among U.S. military personnel within 1 year after combat injury and assess the relationship between the symptom profiles and long-term quality of life (QoL).
The study sample consisted of 885 military personnel from the Expeditionary Medical Encounter Database who completed (1) a Post-Deployment Health Assessment (PDHA) within 1 year following combat injury in Iraq or Afghanistan, and (2) a survey for the Wounded Warrior Recovery Project (WWRP), a longitudinal study tracking patient-reported outcomes (e.g., QoL) in injured military personnel. Fifteen self-reported symptoms from the PDHA were assessed using latent class analysis to develop symptom profiles. Multivariable linear regression assessed the predictive effect of symptom profiles on QoL using the physical (PCS) and mental (MCS) component summary scores from the 36-Item Short Form Survey included in the WWRP. Time between PDHA and WWRP survey ranged from 4.3 to 10.5 years (M = 6.6, SD = 1.3).
Five distinct symptom profiles were identified: low morbidity (50.4%), multimorbidity (15.6%), musculoskeletal (14.0%), psycho-cognitive (11.1%), and auditory (8.9%). Relative to low morbidity, the multimorbidity (β = - 5.45, p < 0.001) and musculoskeletal (β = - 4.23, p < 0.001) profiles were associated with lower PCS, while the multimorbidity (β = - 4.25, p = 0.002) and psycho-cognitive (β = - 3.02, p = 0.042) profiles were associated with lower MCS.
Multimorbidity, musculoskeletal, and psycho-cognitive symptom profiles were the strongest predictors of lower QoL. These profiles can be employed during screening to identify at-risk service members and assist with long-term clinical planning, while factoring in patient-specific impairments and preferences.
本研究旨在确定美国军人在战斗伤害后 1 年内的症状特征，并评估这些症状特征与长期生活质量（QoL）之间的关系。
研究样本包括来自远征医疗遭遇数据库的 885 名军人，他们在伊拉克或阿富汗战斗伤害后 1 年内完成了（1）部署后健康评估（PDHA），以及（2）创伤战士康复项目（WWRP）的调查，这是一项跟踪受伤军人患者报告结果（例如，QoL）的纵向研究。使用潜在类别分析评估 PDHA 中的 15 种自我报告症状，以制定症状特征。使用 WWRP 中包含的 36 项简短健康调查的身体（PCS）和心理（MCS）综合评分，多变量线性回归评估症状特征对 QoL 的预测效果。PDHA 和 WWRP 调查之间的时间范围为 4.3 至 10.5 年（M=6.6，SD=1.3）。
确定了五个不同的症状特征：低发病率（50.4%）、多种疾病（15.6%）、肌肉骨骼（14.0%）、心理认知（11.1%）和听觉（8.9%）。与低发病率相比，多种疾病（β=-5.45，p<0.001）和肌肉骨骼（β=-4.23，p<0.001）特征与较低的 PCS 相关，而多种疾病（β=-4.25，p=0.002）和心理认知（β=-3.02，p=0.042）特征与较低的 MCS 相关。
多种疾病、肌肉骨骼和心理认知症状特征是 QoL 较低的最强预测因素。这些特征可在筛选期间用于识别高危现役军人，并协助长期临床规划，同时考虑患者的特定损伤和偏好。
