BACKGROUND/RATIONALE:
Demobilization and returning home after combat can be challenging. OEF/OIF veterans have an unusually high prevalence of traumatic brain injury (TBI), Posttraumatic Stress Disorder (PTSD), and depression, conditions that present substantial challenges for community reintegration. Early evidence suggests that military personnel who deployed to Iraq return with deficits in sustained attention, verbal learning, and visual-spatial memory as well as increased prevalence of negative state affect, measures of confusion and tension as compared to those who did not deploy. While the etiology of these impairments is not well understood, it seems likely they will have implications for social and occupational functioning. Our current understanding of the effects of poor post deployment reintegration stems largely from the experience of Vietnam war veterans, a disproportionate number of whom have had pervasive difficulties in their everyday lives. In fact, more than one third of homeless men in the United States are veterans. Because more women have entered the armed forces, the face of today's military is quite different than that of the Vietnma era. Our knowledge of the reintegration difficulties of female veterans following deployment is scant. Thus, the early identification and prevention of problems in community reintegration and the promotion of greater function of this population is an important mandate for the VA.
OBJECTIVE(S):
The objectives of this proposal are to: 1) to develop a research agenda of mutual interest with researchers and clinicians from the Brooke Army Medical Center 2) to continue psychometric testing of the paper-and-pencil version of the Community Reintegration of Service Members (CRIS), a new veteran-centric measure of community reintegration specific to veterans, in preparation for development of a computer adaptive test, 3) to test the responsiveness of the CRIS measure in a sample of 50 patients from Brooke Army Medical Center, and 4) to explore issues in adjustment to community living following deployment for female veterans.
METHODS:
We will coordinate a planning meeting with researchers and clinicians at Brooke Army Medical center. Phase will be involve psychometric testing of the CRIS will be achieved through a field study of 50-75 veterans recruited from the Providence VA. We will examine test-retest reliability of the measure, construct validity, internal consistency of the measure's subscales and perform preliminary IRT analyses of item difficulty. Responsiveness of the CRIS will be evaluated by examining change scores in a group of veterans before and after rehabilitation at Brooke Army Medical Center. Additionally we will conduct a qualitative study of key informants and female OEF/OIF veterans. Data will be collected through individual interviews and focus groups.
FINDINGS/RESULTS:
Objective 1: A planning meeting was held between Providence VA Medical Center TREP investigators and researchers and clinicians from Brooke Army Medical Center for the Intrepid (CFI). At the conclusion of the meeting plans for a study of CRIS responsiveness at the CFI were finalized.
Objective 2: The CRIS was administered to a convenience sample of 76 subjects from the PVAMC. Sixty-six subjects completed the CRIS again in one week and were administered the SF-36, a QOL measure and the CHART. Results show that the unidimentionality of the CRIS scales improved from our first pilot study. Scale alphas showed excellent internal consistency (.92-.94). All scales demonstrated excellent test-retest reliability (ICCs .92-.94). As hypothesized, ANOVAs showed differences in CRIS scale scores between groups. Veterans who were working had higher scores on the CRIS than those who were not working. Veterans with PTSD had lower scores on all scales, as did those with substance abuse history or mental health problems as compared to veterans without these diagnoses. These results demonstrate validity and reliability of the CRIS instrument.
Objective 3: No findings as of yet.
Objective 4: No findings as of yet.
IMPACT:
The findings from objective 2 were used to refine the CRIS measure. Work is currently underway in a VA HSR&D funded Merit review to develop a computer adaptive test version of the CRIS which will decrease respondent burden and increase utility for use in the VA system.
PUBLICATIONS:
Journal Articles
- Resnik L, Allen SM, Isenstadt D, Wasserman M, Iezzoni L. Perspectives on the use of mobility equipment in a diverse population of seniors. The Gerontologist. 2008.
- Resnik L, Liu D, Mor V. Benchmarking physical therapy clinic performance: statistical methods to enhance internal validity when using observational data. Physical Therapy. 2008; 88(9): 1078-1087.
- Resnik L, Liu D, Mor V, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Physical Therapy. 2008; 88(9): 989-1004.
- Resnik L, Plow M, Jette A. Development of the CRIS: A Measure of Community Reintegration of Injured Service Members. Journal of Rehabilitation Research and Development. 2008.
- Resnik L, Allen SM. Using the International Classification of Function to Understand the Challenges in Community Reintegration of Injured Service Member. Journal of Rehabilitation Research and Development. 2008.
- Werneke M, Hart D, Resnik L, Stratford P, Reyes A. Centralization: Prevalence and Effect on Treatment Outcomes Using a Standardized Operational Definition and Measurement Method. The Journal of Orthopaedic and Sports Physical Therapy. 2008; 38(3): 116-125.
