title: The outcome of British combat amputees in relation to military service.
abstract: BACKGROUND
  The study aim was to determine the outcome, in relation to military service in UK military combat amputees.
  
  
  METHODS
  Casualties were assessed at mean 2.4 years after injury and graded by a Functional Activity Assessment (FAA) ranging from 1 (fully fit) to 5 (unfit all duties) to score vocational functional outcome. ISS were calculated and the patients were categorised as having unilateral or multiple amputations. The Short Form-36 Health Survey (SF-36) was completed.
  
  
  RESULTS
  Of the 52, 8 patients had left the forces by medical discharge, with 44 continuing to serve. 33 of the 44 had returned to work. 50 patients had FAA grades and were at least 7.6 months post-injury. No patients were graded as FAA1, 8 as FAA2, 18 as FAA3, 19 as FAA4 and 5 as FAA5. There was a trend for the FAA score to increase with injury severity, as measured by ISS i.e. vocational functional outcome was worse with more severe injuries, although this did not reach statistical significance (p=0.095). Multiple amputee patients had significantly higher FAA grades (p<0.001) and were all FAA 4 or 5. Of the 33 patients who had returned to work, 8 were FAA2, 12 FAA3 and 12 FAA4. The mean SF-36 scores for Physical Component Summary (PCS) increased significantly from 36.4 to 43.4 (p=0.001) with rehabilitation, while Mental Component Summary (MCS) was 53.0 and remained similar at 53.6 (p=0.987). MCS scores were similar in these patients to the normal population, 50 (SD 10).
  
  
  CONCLUSIONS
  This study is the first to report the outcomes, with regards to return to work, of the UK military amputees injured in Afghanistan and Iraq Soldiers are surviving more severe and complex injuries than before and the majority are able to return successfully to military work. SF-36 PCS scores improve significantly with rehabilitation, and while MCS scores remain constant, the initial assessments are comparable with a normal population.
authors.affiliation: Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey KT18 6JW, UK. shreshth@datta.org
authors.forename: Shreshth
authors.initials: S
authors.lastname: Dharm-Datta
authors.forename: John
authors.initials: J
authors.lastname: Etherington
authors.forename: Alan
authors.initials: A
authors.lastname: Mistlin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rees
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clasper
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D009104:Multiple Trauma; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult