Health-related quality of life in active duty military: A secondary data analysis of two randomized controlled trials.

BACKGROUND: Military service members with lower extremity injuries are at risk for compromised health-related quality of life during rehabilitation. PURPOSE: The purpose of this secondary data analysis was to examine changes in self-perceived physical and mental health in two clinical trials of military service members during rehabilitation for a lower extremity injury. METHODS: This study is a secondary analysis of existing data from two cohorts of active duty military service members with lower extremity injuries as they participated in separate randomized controlled trials. DISCUSSION: A similar pattern for both physical and mental health was observed in both groups of participants. Perceptions of physical health improved significantly in both studies, whereas mental health perceptions may or may not have declined. CONCLUSION: Increased attention to mental health may be important during rehabilitation after major and minor lower extremity injuries. Although perceptions of physical health improve, corresponding changes may not occur in mental health perceptions.

Self-Managed Strength Training for Active Duty Military With a Knee Injury: A Randomized Controlled Pilot Trial.

INTRODUCTION: Knee injuries among active duty military are one of the most frequent musculoskeletal injuries and are often caused by exercise or intense physical activity or combat training. These injuries pose a threat to force readiness. Our objective was to assess feasibility (including recruitment and retention rates) of three self-managed strengthening strategies for knee injuries and determine if they resulted in improvements in lower extremity strength, function, pain, and activity compared to usual physical therapy (PT) in military members. METHODS: A pilot study using a randomized controlled trial was conducted at three outpatient military medical treatment facilities. After baseline testing, 78 active duty military members with a knee injury were randomized to 1-4 trial arms: (1) neuromuscular electrical stimulation (NMES) applied to the quadriceps muscle; (2) graduated strength walking using a weighted vest (WALK); (3) combined NMES with strength walking (COMBO); (4) usual PT alone. All groups received usual PT. The primary outcome was the rates of change in knee extensor and flexor strength over 18 weeks. Secondary outcomes explored the rates of change in functional performance, pain, and activities of daily living scale (ADLS). The primary analysis for the endpoints used repeated measures, linear mixed-effects models. This study was approved by Institutional Review Boards at all facilities. RESULTS: The randomized sample (N = 78) included 19 participants in the PT-only, 20 in the WALK, 19 in the NMES and 20 in the COMBO groups. At baseline, there were no group differences. Fifty of the participants completed the 18-week study. The completers and non-completers differed at baseline on injury mechanism, with more completers injured during sports (45% vs 29%), and more non-completers during military training (36% vs 18%). Also, they differed in uninjured knee extension (completers 28% weaker), and uninjured knee flexion (completers 22% weaker). Adherence for self-reported daily step logs showed that the WALK group was 15% below goal and COMBO group 6% below goal. The 300 PV muscle stimulator showed the NMES group completed 34% of recommended stimulation sessions and the COMBO group 30%.Knee extension strength in the injured knee found only the COMBO group having a statistically higher improvement compared to PT-only (Change over 18 weeks: 10.6 kg in COMBO; 2.1 kg in PT-only). For the injured knee flexion changes, only the COMBO showed significant difference from PT-only (Change over 18 weeks: 7.5 kg in COMBO; -0.2 kg in PT-only). Similarly, for the uninjured knee, only the COMBO showed significant difference from PT-only in knee extension (Change over 18 weeks: 14.7 Kg in COMBO; 2.7 kg in PT-only) and knee flexion (Change over 18 weeks: 6.5 kg in COMBO; -0.2 kg in PT-only). Overall pain improved during the study for all groups with no significant group differences. Similarly, function and ADLS significantly improved over 18 weeks, with no significant group differences. CONCLUSIONS: Knee extensor strength improvements in the COMBO group were significantly higher compared to usual PT. Pain, functional measures, and ADLS all improved during the study with no group differences. Further research is required to confirm these findings.

Examining health outcomes: the case of maternal epilepsy.

The paper examines the history and health outcome of a 21-year epileptic woman who was expecting her first child. At the initiation of the study period, the young woman was in her 8th month of pregnancy. Over a three month period, this study reflects upon her epileptic history/status, medical care, medication, and the health outcome of both the mother and infant following the pregnancy. The primary mode of assessment was a structured personal interview.