Physical Rehabilitation of Military Amputees

Abstract

The numbers of UK military personnel severely injured during combat was most recently at its highest during and after the conflicts in Iraq and Afghanistan. These conflicts created a relatively large population of young servicemen and women with exceptional long-term healthcare and rehabilitation needs not seen or treated in the UK or globally before. Despite having a combat casualty care pathway being described as ‘exemplary’ by the Care Quality Commission, the UK Defence Medical Services (DMS) are yet to provide evidence detailing the impact of their care pathway on the health and well-being of their severely injured patients with traumatic lower-limb amputation(s) (LLA). The first aim of this thesis (chapter 4) was to perform a retrospective analysis of functional and mental health outcomes in military personnel with traumatic LLA measured at their last in-patient admission to Defence Medical Rehabilitation Centre (DMRC) Headley Court. This found clinical outcomes indicative of full-preparedness for community integration. Previous research has indicated that individuals with traumatic LLA are at increased risk of a physical inactivity and a range of secondary health conditions, including obesity and compromised cardiometabolic health. Strategies to mitigate this risk have become a priority for DMS. The primary research question of this thesis (chapter 6 and 7) was to determine within and between group differences in physical activity (PA), physical function, body composition and components of cardiometabolic health in military personnel with unilateral and bilateral LLA. A 20 week longitudinal study was performed, consisting of two 4 week in-patient admissions of rehabilitation and two 6 week active recovery blocks at home. These measures were then compared against an age-matched normative control group employed within active roles within the UK Ministry of Defence. Before measuring PA during rehabilitation and at home it was important to first ensure the methods used were accurate and valid for the population of interest. Wearing an Actigraph GT3X+ triaxial accelerometer on the hip of the shortest residual limb and using a predictive model incorporating heart rate offers the most accurate prediction of PA energy expenditure (PAEE) in those with traumatic LLA (85%, 87% and 83% of the variance in PAEE for the unilateral, bilateral and control group, respectively). Chapter 6 and 7 found military personnel with unilateral LLA have a similar capacity for PA, and demonstrated comparable body composition and components of cardiometabolic health as active normative controls. Despite demonstrating levels of function and psychosocial health indicative of full-preparedness back into society, estimated daily PAEE in bilateral LLA was significantly reduced during habitual living in their home environments. The bilateral LLA group demonstrate unfavourable body composition (particularly the distribution of adipose tissue around the abdomen). This was also accompanied by an increased risk of cardiovascular disease and compromised metabolic health, with 63% being classified with metabolic syndrome. To support and manage the long-term health and well-being of military personnel with bilateral LLA, future research should aim to investigate strategies that promote regular engagement in PAEE and/or structured exercise whilst at their home environment.

Date of Award	24 Jun 2020
Original language	English
Awarding Institution	University of Bath
Supervisor	James Bilzon (Supervisor), Polly McGuigan (Supervisor) & Alexander Bennett (Supervisor)