An acute injury or serious health event can be life-changing, but effective rehabilitation can play an important role in the recovery process. Rehabilitation is considered the restoration of an individual or body part to normal or near normal function after a disabling disease, injury, or addiction.1
About Rehabilitation
Recovering from an injury takes time and effort, but not all rehabilitation efforts focus specifically on injury. Some rehabilitation therapies are designed to address life skills, 2 and other therapies focus on specific physical skills. Rehabilitation also is different according to type of injury and age group; for example, an older person affected by a chronic illness will have different rehabilitation needs than someone younger who may be recovering from an acute injury.3
Depending on the condition, rehabilitation goals may focus on: 4
- physical therapy to strengthen muscles and regain mobility,
- occupational therapy to assist with the activities of daily living,
- speech or language therapy, and/or
- treating and managing chronic pain.
Rehabilitation can take place in a therapist's office or inpatient facility devoted specifically to patients requiring intensive treatment. For patients who may not be able to travel easily, rehabilitation therapies can be done at home, and may sometimes involve the patient's family members. Many rehabilitation specialists encourage a team approach 5 to recovery, involving mental health specialists as well as physical or occupational therapists. Moreover, a team approach can address other concerns-such as depression or financial problems-that sometimes result from the initial injury or illness and prolonged rehabilitation.
HSR&D Research
The nature of combat service gives rise to many acute injuries; further, the aging veteran population is uniquely affected by a number of chronic illnesses. Together, these factors necessitate careful and effective rehabilitation treatment and research. Here are some examples of HSR&D research in this area.
Promoting Successful Rehabilitation
VA/HSR&D's Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI) was established to promote the successful rehabilitation, psychological adjustment, and community reintegration of OIF/OEF veterans. For example, PT/BRI-QUERI is working closely with VHA Physical Medicine and Rehabilitation to enhance the VA's system for monitoring rehabilitation care processes and outcomes. To learn more about the QUERI program and PT/BRI-QUERI, go to
http://www.hsrd.research.va.gov/queri/default.cfm.
Outcomes for OIF/OEF Veterans Receiving Care at Polytrauma Rehabilitation Centers 6
Multiple trauma, or polytrauma, and blast-related injuries are some of the most prevalent injuries sustained by combat veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Further, estimates indicate that more than 60% of blast-related injuries result in traumatic brain injury (TBI). Recognizing that these injuries require special care, VA designated four Polytrauma Rehabilitation Centers (PRCs) to provide specialized rehabilitation treatment and to expand clinical expertise in polytrauma throughout VA.
This HSR&D study examined the characteristics and rehabilitation outcomes of 188 OIF/OEF veterans who received inpatient rehabilitation for blast and other injuries from October 2001 through January 2006. This retrospective, observational study used VA administrative data and chart review to examine injury type, impairment, improvement in cognitive and motor function, and length of stay in the PRC.
In findings published in the January 2008 issue of the Archives of Physical Medicine and Rehabilitation, investigators noted that type of injury did not predict functional outcomes; however earlier acute rehabilitation intervention was positively associated with gains in cognitive function scores. Further, the study showed an association between shorter length of inpatient stay and greater functional independence at admission.
Authors note that the PRC stay is only part of the continuum of care needed to address the life-long needs of these complex patients, and suggest that future research examine outcomes over time. The findings are of particular importance as VA continues developing services for the significant numbers of veterans that have sustained polytrauma and blast-related injuries as a result of active duty in OIF/OEF.
Evaluating a Polytrauma and Brain Injury Rehabilitation Program 7
Veterans affected by polytrauma and brain injury often have the potential for significant independence. Transitional rehabilitation programs offer comprehensive residential services for those who no longer need intensive inpatient care. Transitional programs are new to VA, and investigators in this study sought to develop and test strategies to improve quality of life, patient satisfaction, and community reintegration for veterans in transitional rehabilitation programs.
The study included three specific objectives:
- to identify learning needs of providers in the transitional program;
- to determine the content and process of educational program to meet the needs of those providers; and
- to determine the feasibility, test burden, and content validity of various outcomes measures for patients and their families.
While results are not yet available, researchers hope to gain further understanding from both providers' and patients' perspectives. This new knowledge will be used to develop evidence-based staff training programs that are expected to improve rehabilitation outcomes in veterans who have sustained polytrauma or blast injuries.
The Hearing Aid Effectiveness After Aural Rehabilitation (HEAR) Trial 8
Use of hearing aids among veterans has increased almost four times in the last decade. In 1996, VA distributed 75,000 hearing aids, and in 2003, 283,000 were dispensed. However, the number of audiologists has less than doubled during that same period. As a result, waiting times for audiology appointments has increased, which can have a negative impact on the quality of life for thousands of our nations veterans. Investigators in this study are looking at whether group visits for audiology appointments are as effective as individual visits; whether those visits can lead to lower costs and lower waiting times; and whether those visits will improve hearing-related quality of life six months after the initial hearing-aid fitting.
Findings from this study are expected to help VA leadership identify more efficient treatments that maintain high quality care for hearing loss, a common disability among veterans. Results are also expected to provide insight into the value of group visits as a useful, cost-effective care model.
Rehabilitation and Geographic Access 9
Many of today's younger veterans are returning from active duty in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) with injuries that require intensive, long-term rehabilitation. However, little is known about the overall ability for OEF/OIF veterans to access rehabilitation services.
Investigators in this retrospective, observational study that was conducted from October 2006 to September 2007 examined a group of OEF/OIF veterans who accessed VHA facilities for rehabilitation from injuries sustained during active duty. The study had two key goals: 1) to learn more about veterans' access to different levels of VHA rehabilitation services, as well as their potential need for future rehabilitation services; and 2) to investigate veterans' use of both inpatient and outpatient health services.
Findings show that investigators identified hearing impairment as the most common traumatic injury requiring some form of rehabilitation. Investigators determined that overall, VA provided reasonable access to polytrauma rehabilitation care to 87 percent of inpatient and 88.3 percent of outpatient veterans. Study results point toward the need for remaining VA rehabilitation resources to be located where there is the greatest need for those services. Further, investigators emphasize that new resources should be geographically located where they will provide the largest impact in terms of filing service gaps and unmet needs. Preliminary results from this study were included in a Management Report denoting potential access gaps that was submitted to the National Program Office for Physical Medicine and Rehabilitation.
References
- Mosby's Medical, Nursing, and Allied Health Dictionary, 4E, Anderson, K. et al, Ed. (p. 1345). Mosby, Inc. St. Louis, MO. 1994
- Ohio State University Medical Center website. About Rehabilitation.
- Merck Manual: Home Edition Online. Fundamentals: Rehabilitation-Introduction.
- National Institutes of Health Medline Plus. Rehabilitation: Introduction.
- Merck Manual: Home Edition Online. Fundamentals: Rehabilitation-Introduction.
- Sayer, N. PhD., et al, "Characteristics and Rehabilitation Outcomes Among Patients with Blast and Other Injuries Sustained During the Global War on Terror". Arch of Phys Med and Rehab. Jan 2008. 89(1):163-70.
- Scott, S. G., Evaluation of Polytrauma Brain Injury Rehabilitation Transitional Program. James A. Haley Veterans Hospital, Tampa Tampa, FL. (May 2008 - September 2008)
- Collins, M. P., PhD, MS. The Hearing Aid Effectiveness After Aural Rehabilitation (HEAR) Trial.. VA Puget Sound Health Care System, Seattle, WA. (January 2006 - December 2008).
- Cowper Ripley, D.C., PhD, MA. Geographic Access to VHA Rehabilitation Services for OEF/OIF Veterans.. North Florida/South Georgia Veterans Health System, Gainesville, FL. (October 2006 - September 2007)
