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  • Veterans with PTSD and/or Depression More Likely to Participate in Cardiac Rehabilitation than Veterans without These Disorders
    This study sought to determine whether Veterans with depression and/or PTSD were more or less likely than those without depression or PTSD to participate in cardiac rehabilitation (CR) programs following hospitalization for heart attack or coronary revascularization. Findings showed that Veterans with PTSD and/or depression were more likely to participate in CR than Veterans without these mental health disorders. Between 2010 and 2014, cardiac rehabilitation participation rates were consistently higher in patients with PTSD or depression (9-12%) than in those without either condition (7-11%). Investigators found that in comparison to Veterans without PTSD or depression, the odds of participation in CR were 24% greater in patients with depression alone, 38% greater in patients with PTSD alone, and 57% greater in patients with both PTSD and depression. Investigators were not able to determine why patients with mental disorders were more likely to participate in cardiac rehabilitation. Overall participation in cardiac rehabilitation is low in patients with coronary heart disease, but the presence of PTSD or depression does not reduce participation further.
    Date: June 4, 2019
  • Veterans with Heart Disease More Likely to Participate in Cardiac Rehabilitation (CR) When Home-Based CR Program is Available
    This study examined whether the implementation of new home-based cardiac rehabilitation (HBCR) programs is associated with improved cardiac rehabilitation (CR) participation among Veterans. Findings showed that Veterans hospitalized with ischemic heart disease were more likely to participate in CR when a home-based program was available. Implementation of HBCR increased participation from 6% to 25%, and was associated with four-fold greater odds of participation. Overall, participation in at least one CR session increased from 8% to 13%. Veterans offered HBCR were less likely to drop out after the first session than were those for whom HBCR was not available. Home-based cardiac rehabilitation may be an effective tool for increasing CR participation among Veterans who would otherwise decline participation, thereby improving patient outcomes.
    Date: January 22, 2018
  • Study Compares Stroke Care in VA Community Living Centers with Private, VA-Contracted Nursing Homes
    This study is part of a larger investigation comparing the use and functional outcomes between Veterans in VA community living centers (CLCs) and VA-contracted community nursing homes (CNHs). Findings showed that compared with Veterans residing at CNHs, Veterans residing at CLCs had fewer average rehabilitation therapy days (both adjusted and unadjusted), but were significantly more likely to receive restorative nursing care. For rehabilitation therapy, Veterans in CLCs had lower user rates (75% vs. 76%) and fewer observed therapy days (4.9 vs. 6.4) compared to Veterans in CNHs. For restorative nursing care, Veterans in CLCs had higher user rates (34% vs. 31%), more observed average care days (9.4 vs. 5.9), and more adjusted days for restorative nursing care.
    Date: March 1, 2016
  • Under-utilization of Cardiac Rehabilitation for Veterans Hospitalized for Ischemic Heart Disease
    This study sought to determine: 1) the proportion of Veterans with ischemic heart disease (IHD) who participate in cardiac rehabilitation (CR); 2) whether the presence of an onsite CR program was associated with greater participation; and 3) patient characteristics associated with participation. Findings showed that only 8% of the Veterans in this study who had been hospitalized for MI, PCI, or CABG participated in one or more sessions of outpatient cardiac rehabilitation. Overall, Veterans were more likely to participate in CR if they had been hospitalized at a VA facility with an onsite CR program versus without one (11% vs. 7%). However, participation was extremely low regardless of the presence or absence of an onsite program. Characteristics associated with greater participation in CR included: younger age, being married, higher BMI, living closer to a VA facility, hyperlipidemia, absence of heart failure, absence of chronic kidney disease, and hospitalization for CABG (vs. PCI or MI). After controlling for these variables, the presence of an onsite CR program was associated with 75% greater odds of attending a CR program.
    Date: August 18, 2014
  • Rehabilitation Settings for Veterans Following Hospital Discharge for Hip Fracture
    This study explored the factors that impact choice of VA rehabilitation setting after acute hip fracture repair procedures. Findings showed that following hospitalization for hip fracture, nearly half (48%) of the Veterans in this study were discharged directly home – without VA-paid rehabilitation. Few Veterans (0.8%) were discharged with home health, with higher proportions discharged to a nursing home (15%), outpatient rehabilitation (19%), or inpatient rehabilitation (17%). Veterans with higher comorbidity scores were less likely to be discharged to inpatient rehabilitation. Veterans were more likely to be discharged to non-home settings if they had total functional dependence, had high American Society of Anesthesiology (ASA) class scores, had one or more surgical complications, or lived in counties with lower nursing home bed occupancy rates. Thus, it appeared that the most vulnerable patients were provided inpatient care. Surgical complications were the most significant predictor of discharge setting, but the availability of community resources also was an important predictor.
    Date: January 1, 2014
  • Pain and PTSD Common Comorbidities among OEF/OIF Veterans with Spinal Cord Injury Undergoing Inpatient Rehabilitation
    Pain and PTSD were more likely to manifest as comorbidities than as isolated conditions during inpatient rehabilitation for spinal cord injury. Comorbid pain and PTSD symptoms were more common than either condition alone, and nearly as common as not having either condition. Veterans with pain at the beginning of rehabilitation showed declines in pain ratings over the course of rehabilitation. In contrast, Veterans in the “PTSD Alone” group showed increasing pain over the course of rehabilitation. Factors not associated with pain and PTSD status were: demographic and SCI characteristics, number of comorbid traumatic injuries, and the prevalence of individual comorbid injuries.
    Date: August 1, 2012
  • TeleRehab Improves Physical Function in Veterans with Stroke
    This trial sought to determine the effects of a multi-faceted Stroke Tele- Rehabilitation (STeleR) intervention on physical function, and secondarily on disability, in community-dwelling Veterans who had experienced a stroke within the past two years. The STeleR intervention significantly improved lower body physical functioning in Veterans with stroke. Most gains in physical functioning and other improvements occurred during the initial 3 months of the study, but were maintained during the subsequent 3 months during which no STeleR services were provided. The STeleR intervention also improved Veterans’ ability to perform life tasks such as “take part in regular fitness program” and management of social tasks that involve minimal mobility or physical activity, such as “take care of own health.” The authors suggest the STeleR intervention could be a useful supplement to traditional post-stroke rehabilitation given the limited resources available for in-home rehabilitation for stroke survivors.
    Date: May 24, 2012
  • Missed Opportunities to Improve Management of Poorly Controlled Diabetes at VA Hospital Discharge
    Despite evidence of poor diabetes control prior to admission, less than one-quarter (22%) of the Veterans in this study received a change in outpatient diabetes therapy upon hospital discharge, suggesting widespread clinical inertia. Nearly one-third of Veterans (32%) had no change in therapy, no documentation of HgbA1c within 60 days of discharge, and no follow-up appointment within 30 days of discharge. Patients admitted to surgical, psychiatric, or rehabilitation services were less likely to have a change in outpatient therapy compared to patients admitted to medical services. In an adjusted analysis, factors associated with higher odds of a change in diabetes therapy included: inpatient endocrinology consultation, higher pre-admission HgbA1c, higher mean blood glucose during admission, occurrence of inpatient hypoglycemia, and inpatient basal insulin therapy.
    Date: March 30, 2012
  • Prevalence and Risk Factors for Non-Fatal Injuries among Veterans with TBI – Post-Discharge from VA Polytrauma Care
    This study examined the prevalence of, and potential risk factors for, non-fatal injuries among Veterans with TBI after discharge from VA inpatient polytrauma rehabilitation programs. Caregivers reported that nearly one-third (32%) of Veterans discharged from VA Polytrauma Rehabilitation Centers had incurred subsequent, medically treated injuries; most were associated with falls (49%) and motor vehicles (37%). Factors associated with Veterans’ increased odds of subsequent injury included poor or fair general health and requiring assistance with activities of daily living or instrumental activities of daily living. A number of caregiver-reported ongoing symptoms/health problems among Veterans (e.g., depression, vision loss, hearing loss) were also associated with greater injury odds. Moreover, the odds of subsequent injury increased as the number of reported symptoms/comorbid health problems increased. Compared to male Veterans, the small proportion of female Veterans (n=23) had approximately four and a half times the odds of sustaining subsequent injury. Caregivers who reported their own health as poor or fair were more likely to report subsequent injuries for Veterans compared to caregivers who reported their own health as excellent, very good, or good. Caregivers with higher than average or average depressive or anxiety symptoms, or lower than average physical functioning scores, also were more likely to report injuries among Veterans compared to caregivers without these symptoms.
    Date: January 1, 2012
  • Cognitive Processing Therapy Improves PTSD Symptoms More than Usual Care among Veterans in Residential Rehabilitation Program
    This study examined one VA PTSD Residential Rehabilitation Program and compared clinical outcomes for two cohorts of male Veterans with PTSD that were treated with either cognitive processing therapy (CPT) or trauma-focused group treatment as usual (TAU). Findings showed that Veterans treated with CPT experienced more improvement of PTSD and depression symptoms, psychological quality of life, coping, and psychological distress than Veterans who received TAU. In the CPT cohort, more Veterans reported PTSD symptoms that were classified as recovered or improved, compared to the TAU cohort.
    Date: October 1, 2011
  • Profile of Caregivers and Care Provided for OEF/OIF Veterans Following Acute Rehabilitation for TBI and Polytrauma
    The Family and Caregiver Experience Study (FACES) sought to describe the care and support needs of OEF/OIF Veterans with moderate to severe polytrauma after they received acute rehabilitation – and to describe the providers of that care. Findings showed that a significant portion of caregivers provide time-consuming, unpaid care for Veterans, years after injury. Policymakers may need to target additional resources to meet the long-term needs of caregivers who may not be eligible for support mandated by the Caregivers and Veterans Omnibus Health Services Act of 2010.
    Date: August 25, 2011
  • Veterans Reporting a History of Military Sexual Trauma are Treated in a Variety of VA Outpatient Mental Health Settings
    This study sought to determine the VA mental health outpatient settings in which patients with military sexual trauma (MST) are most likely to be treated, which might help set priorities for targeted MST-related education and training. Findings showed that more than one-third of female Veterans (36%) and 2% of male Veterans seen in VA outpatient mental healthcare settings during FY08 reported a history of military sexual trauma. Both women and men with MST were more likely to use more than one type of mental health clinic setting, compared to those without MST. A significantly larger proportion of women seen in MST specialty clinics reported MST as compared to all other settings (81% vs. 34%). However, there was a wide range of clinic visit settings for female Veterans with MST, including: MST specialty clinics, PTSD specialty clinics, psychosocial rehabilitation, and substance use disorder clinics. Male Veterans represented a small proportion of patients seen in all clinics, and a larger proportion of men seen in MST specialty clinics reported MST as compared to other settings (56% vs. 2%). These findings indicate that mental health providers who treat women Veterans, even if they work in settings that do not traditionally incorporate interventions focused on traumatic stress, may encounter issues related to MST. Therefore the authors suggest that training in how to respond to sexual trauma disclosure be an important component in all VA mental healthcare settings.
    Date: May 1, 2011
  • JRRD Single-Topic Issue Reports on Results of First National Survey of Veterans with Traumatic Limb Loss
    This issue of JRRD reports the results of the first nationally representative survey of Vietnam Veterans and service members and Veterans from OEF/OIF who sustained major traumatic limb loss while serving. Members of a Prosthetics Expert Panel, which included 27 professionals from academic and clinical settings, clinicians and researchers from VA and DoD, and three Veterans with limb loss, analyzed Survey findings. Panel members then wrote articles based on the Survey data, presenting survey findings as well as Expert Panel recommendations.
    Date: June 1, 2010
  • Predictors of Veterans’ Use of Mental Health Services
    Findings show that being older, female, having greater clinical need, lack of enabling resources (e.g., employment, stable housing, social support), and fewer problems with access to treatment significantly predicted increased mental health services use over the three-month follow-up period. Results also show that fewer outpatient mental health visits did not adversely affect clinical outcomes. Findings support VA’s ongoing commitment to provide special programs and initiatives focused on easing access to mental health services, vocational rehabilitation, and housing assistance.
    Date: April 1, 2010
  • Better Outcomes for Veteran Amputees Receiving Specialized Rehabilitation Compared to Consultative Services
    Veterans who receive specialized rehabilitation can be expected to make comparatively higher gains than Veterans who receive consultative services, regardless of timing and clinical complexity. Advanced age, trans-femoral amputation, paralysis, serious nutritional compromise, and psychosis were associated with lower gains in physical function. Most Veterans (89.1%) received early rehabilitation occurring directly after surgery vs. late rehabilitation beginning during a separate hospitalization after discharge from the index surgical stay. Authors suggest that clinicians consider adjusting prognostic expectations to both clinical severity and the type of rehabilitation patients receive.
    Date: April 1, 2010
  • Characteristics and Needs of Veteran Cancer Survivors
    Findings show that 11% of the Veterans treated within the VA healthcare system in FY07 were cancer survivors. The most common cancer types were prostate, skin (non-melanoma), and colorectal. Compared to the general population, Veteran cancer survivors are older (84% are older than 60) and predominantly male (97%). Cancer site prevalence statistics vary between the VA and general U.S. cancer patient populations due to differences in age, gender, and risk factors. Overall, the four common symptom concerns reported by cancer survivors are sexual dysfunction, fatigue, anxiety, and depression. The authors suggest that Veteran-specific research is needed on topics such as cancer survival among older Veterans, and the role of military exposures (physical, emotional, and psychological) in causing cancer and impacting recovery. The authors also suggest that four models of care may be relevant to improving care for Veterans who have survived cancer: 1) cancer survivorship clinics, 2) cancer care transition plans, 3) rehabilitation, and 4) chronic disease management. These models of care may help integrate the physical and mental health needs of cancer survivors.
    Date: March 1, 2010
  • Special Issue of Pain Medicine Highlights VA Research on Pain among OEF/OIF Veterans
    This publication is in follow-up to a Pain Research Summit held in September 2007 by VA’s Rehabilitation R&D Service and VA/HSR&D’s Polytrauma and Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI-QUERI). This Special Issue begins with four articles that build on the growing epidemiological literature on the prevalence and correlates of pain among OEF/OIF Veterans, and considers the evidence for the assessment and management of pain in this population. The Issue also includes several original articles that provide a sample of the relatively large and growing body of research on pain, including research that focuses on the most prevalent and challenging of pain conditions observed among OEF/OIF Veterans, such as neuropathic pain, chronic widespread pain, musculoskeletal/joint pain, and pain secondary to spinal cord injury.
    Date: October 1, 2009
  • Geographic Access to Rehabilitation for OEF/OIF Veterans
    This study sought to ascertain specific geographic areas where the need for VHA rehabilitation services appears greatest and potential access gaps may exist. Findings show that VA provides access to rehabilitation care for the majority of traumatically injured OEF/OIF Veterans; however, more than 10% of Veterans may have potential access barriers due to excessive travel time. For the combined cohort, the median distance to Level I, Level II, and Level III facilities was 411 miles, 121 miles, and 64 miles respectively, and the median distance to the closest VA facility was 22 miles. Clark County, Nevada, and El Paso County, Texas had the highest number of patients with potential access gaps due to excessive travel times.
    Date: October 1, 2009
  • Improving Acute Care for Elders at Risk for Poor Hospital Outcomes
    For patients older than age 65, traditional hospital care frequently results in adverse outcomes that increase their risk of mortality, functional dependency, and institutionalization. There are several alternative models to traditional hospital care that have been shown to address these problems and improve outcomes for older patients. One such model is VA’s Geriatric Evaluation and Management (GEM) program, which was launched in 1976 to provide interdisciplinary, multi-dimensional evaluations for elderly Veterans in need of geriatric treatment, rehabilitation, health promotion, and social service interventions. However, alternative models are not widely disseminated. This Editorial challenges healthcare providers to think outside the traditional hospital box. They suggest broadening the implementation and availability of programs such as GEM and Hospital at Home (non-VA program providing hospital-level care of elders in their own homes) for those patients who would benefit from acute care outside a hospital setting.
    Date: September 28, 2009
  • OEF/OIF Veterans with Spinal Cord Injury and Additional Problems Require Timely Intervention to Avoid Rehabilitation Delays
    Soldiers returning from Iraq and Afghanistan with spinal cord injury often have additional medical and psychosocial problems that require timely intervention to avoid significant delays in rehabilitation. Rehabilitation was often delayed because other problems needed to be addressed first.
    Date: March 1, 2009
  • More Daytime Sleeping Predicts Less Functional Recovery among Elderly Undergoing Inpatient Post-Acute Rehabilitation
    More daytime sleep during the rehabilitation stay was associated with less functional recovery from admission to discharge, even after adjusting for other significant predictors (e.g., mental status, reason for admission, and hours of rehabilitation therapy). Further, more daytime sleep remained a predictor of less functional recovery at 3-month follow-up.
    Date: September 1, 2008

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