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Symptom profiles following combat injury and long-term quality of life: a latent class analysis

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Abstract

Purpose

The purpose of this study was to identify symptom profiles among U.S. military personnel within 1 year after combat injury and assess the relationship between the symptom profiles and long-term quality of life (QoL).

Methods

The study sample consisted of 885 military personnel from the Expeditionary Medical Encounter Database who completed (1) a Post-Deployment Health Assessment (PDHA) within 1 year following combat injury in Iraq or Afghanistan, and (2) a survey for the Wounded Warrior Recovery Project (WWRP), a longitudinal study tracking patient-reported outcomes (e.g., QoL) in injured military personnel. Fifteen self-reported symptoms from the PDHA were assessed using latent class analysis to develop symptom profiles. Multivariable linear regression assessed the predictive effect of symptom profiles on QoL using the physical (PCS) and mental (MCS) component summary scores from the 36-Item Short Form Survey included in the WWRP. Time between PDHA and WWRP survey ranged from 4.3 to 10.5 years (M = 6.6, SD = 1.3).

Results

Five distinct symptom profiles were identified: low morbidity (50.4%), multimorbidity (15.6%), musculoskeletal (14.0%), psycho-cognitive (11.1%), and auditory (8.9%). Relative to low morbidity, the multimorbidity (β =  − 5.45, p < 0.001) and musculoskeletal (β =  − 4.23, p < 0.001) profiles were associated with lower PCS, while the multimorbidity (β =  − 4.25, p = 0.002) and psycho-cognitive (β =  − 3.02, p = 0.042) profiles were associated with lower MCS.

Conclusion

Multimorbidity, musculoskeletal, and psycho-cognitive symptom profiles were the strongest predictors of lower QoL. These profiles can be employed during screening to identify at-risk service members and assist with long-term clinical planning, while factoring in patient-specific impairments and preferences.

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Data availability

The data sets analyzed in the present study are not publicly available due to security protocols and privacy regulations, but they are available from the corresponding author on reasonable request and approval by the Naval Health Research Center Institutional Review Board.

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Acknowledgements

The authors are military service members or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. This work was supported by the U.S. Navy Bureau of Medicine and Surgery under work unit no. 60808. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.2009.0014.

Funding

This work was supported by the U.S. Navy Bureau of Medicine and Surgery under work unit no. 60808.

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Authors and Affiliations

  1. Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA

    Andrew J. MacGregor, Amber L. Dougherty, Edwin W. D’Souza, Cameron T. McCabe, Daniel J. Crouch, James M. Zouris & Jessica R. Watrous

  2. Leidos, Inc, San Diego, CA, USA

    Amber L. Dougherty, Edwin W. D’Souza, Cameron T. McCabe & Jessica R. Watrous

  3. Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA

    John J. Fraser

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  1. Andrew J. MacGregor
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  2. Amber L. Dougherty
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  3. Edwin W. D’Souza
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  4. Cameron T. McCabe
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  5. Daniel J. Crouch
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  6. James M. Zouris
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  8. John J. Fraser
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Contributions

AJM conceptualized and designed the study, performed data analysis, and was the lead writer of the manuscript. All authors interpreted the data, critically revised the manuscript for important intellectual content, and approved the final version of the manuscript.

Corresponding author

Correspondence to Andrew J. MacGregor.

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The authors declare they have no conflicts of interest.

Ethical approval

The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.2009.0014.

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MacGregor, A.J., Dougherty, A.L., D’Souza, E.W. et al. Symptom profiles following combat injury and long-term quality of life: a latent class analysis. Qual Life Res 30, 2531–2540 (2021). https://doi.org/10.1007/s11136-021-02836-y

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