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SDR 07-327 – HSR&D Study

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SDR 07-327
Community Reintegration for OEF/OIF Veterans: Research Collaborations
Linda J Resnik PhD MS
Providence VA Medical Center, Providence, RI
Providence, RI
Funding Period: July 2007 - September 2008

BACKGROUND/RATIONALE:
Further testing is needed to evaluate psychometric properties of the CRIS, a new measure of community reintegration. Because CRIS development work was conducted primarily with male veterans, further study of female veterans is needed.

OBJECTIVE(S):
The objectives were 1) to develop a research agenda of mutual interest with researchers and clinicians from the Brooke Army Medical Center 2) to continue psychometric testing of the paper-and-pencil version of the Community Reintegration of Service Members (CRIS), a new veteran-centric measure of community reintegration specific to veterans, in preparation for development of a computer adaptive test, 3) to test the responsiveness of the CRIS measure in a sample of patients from Brooke Army Medical Center, and 4) to explore issues in adjustment to community living following deployment for female veterans.

METHODS:
The activities consisted of separate, but related activities: Objective 1: Study planning meeting; Objective 2: Psychometric Testing: Subjects were administered the CRIS and related measures twice within two weeks. Analyses assessed test-retest reliability, internal consistency, concurrent and known group validity, and dimensionality; Objective 3: Psychometric Testing in a Sample of Severely Wounded Service Members: Subjects completed CRIS scales and related measures twice at least three months apart. A subset were administered the CRIS within 2 weeks. Test-retest reliability, concurrent, known group validity were examined. Objective 4: Reintegration Issues of Female OEF/OIF Veterans: This was a qualitative study of women deployed to OEF/OIF. Focus groups and individual interviews were conducted and data analyzed for key themes.

FINDINGS/RESULTS:
Objective 1: Planning meeting: At the conclusion of the meeting plans for a study of CRIS responsiveness at the CFI were finalized. Objective 2: CRIS had excellent internal consistency and test-retest reliability and excellent construct validity and were unidimensional. CRIS scores were higher for veterans who were working, those without PTSD, substance abuse or mental health problems. Objective 3: ICCs for test-retest reliability were excellent. CRIS scales were moderately correlated with the SF-36 Role Physical, Social Functioning, Role Emotional, and Physical Functioning scales, and with QOL. CRIS scores for all three scales were lower for subjects with PTSD. CRIS scores were lower for those with TBI. CRIS Extent and Satisfaction scales were lower for subjects with depression. CRIS was as responsive to change as other HRQL measures. Objective 4: Common themes reported include Impulsive Marriages, Problems with Marital Intimacy, the "Married with Children" Syndrome, Rejection by Children, Troubled Children, and Isolated Single Women. Results suggest that the demands of family life pose obstacles to adjustment to civilian life in the first several months following deployment, but ultimately facilitates reintegration into social roles.

IMPACT:
The results provide clear evidence that the CRIS measure is reliable, valid, and appropriate for use in veterans with and without severe injury. The findings from objective 2 were used to refine the CRIS measure. Work is currently underway in a VA HSR&D funded Merit review to develop a computer adaptive test version of the CRIS which will decrease respondent burden and increase utility for use in the VA system. Results from our study of female veterans suggest a need for outreach to women in the first few months following return from deployment.

PUBLICATIONS:

Journal Articles

  1. Resnik L, Plow M, Jette A. Development of CRIS: measure of community reintegration of injured service members. Journal of rehabilitation research and development. 2010 Jan 26; 46(4):469-80.
  2. Resnik L, Liu D, Hart DL, Mor V. Benchmarking physical therapy clinic performance: statistical methods to enhance internal validity when using observational data. Physical Therapy. 2008 Sep 1; 88(9):1078-87.
  3. Resnik L, Liu D, Mor V, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Physical Therapy. 2008 Sep 1; 88(9):989-1004.
  4. Resnik LJ, Allen SM. Using International Classification of Functioning, Disability and Health to understand challenges in community reintegration of injured veterans. Journal of rehabilitation research and development. 2008 May 1; 44(7):991-1006.
  5. Werneke MW, Hart DL, Resnik L, Stratford PW, Reyes A. Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method. The Journal of Orthopaedic and Sports Physical Therapy. 2008 Mar 1; 38(3):116-25.
Books

  1. Plow M, Allen SM, Resnik L. Understanding Physical Activity Behavior in Dual Eligible Beneficiaries. 2008.
  2. Resnik L, Allen SM, Isenstadt D, Wasserman M, Iezzoni L. Perspective on Use of Mobility Aids in a Diverse Population of Seniors: Implications for Intervention, Disability and Health. 2008.
  3. Resnik L. Expert practice and clinical outcomes. Elsevier Press; 2006.
Conference Presentations

  1. Resnik LJ, Borgia M. Reliability and Validity of the CRIS Measure in a Sample of Severely Wounded Service Members. Poster session presented at: Brown University Public Health Research Day Annual Meeting; 2010 Apr 13; Providence, RI.
  2. Resnik LJ, Allen SM. Using the ICF to Understand Challenges in Community Reintegration of Injured Military Service Members. Paper presented at: North American Collaborating Center on Family of International Classifications (IFC) Annual Conference; 2008 Aug 27; Quebec City, Canada.
  3. Resnik LJ, Plow M, Jette A. Developing a Measure of Community Reintegration of Injured Service Members. Poster session presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
  4. Resnik LJ. Development of the CRIS: A Measure of Community Reintegration of Injured Service Members. Paper presented at: Boston University Health and Disability Institute Meeting; 2008 Mar 26; Boston, MA.
  5. Resnik L. Measuring Community Reintegration. Paper presented at: VA National Research Week; 2007 May 1; Providence, RI.
  6. Resnik L. Advances in Prosthetic Rehabilitation: Breakthroughs of today and hope for the future. Paper presented at: Disability Awareness Day Independent Living Annual Exhibition; 2006 Nov 1; Providence, RI.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: none
Keywords: Adjustment Disorders, Deployment Related, Operation Enduring Freedom, Operation Iraqi Freedom, PTSD
MeSH Terms: none

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