{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T08:51:27Z","timestamp":1778921487421,"version":"3.51.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","funder":[{"name":"Uniformed Services University of Health Sciences","award":["HU0001-15-2-0003"],"award-info":[{"award-number":["HU0001-15-2-0003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Rehabilitation research of wounded service members (SMs) commonly focuses on physical ability to return to duty (RTD) as a measure of successful recovery. However, numerous factors or barriers may influence a SM\u2019s ability and\/or desire to RTD after lower extremity musculoskeletal trauma. SMs themselves as well as the clinical care team that works with them daily, often for years at a time, both offer unique perspectives on the influential factors that weigh into decisions to RTD. The purpose of this study was to identify the intrinsic and extrinsic factors patients and clinicians recognized as influencing the decision to RTD after severe lower extremity trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Thirty-two SMs with severe lower extremity trauma (amputation and lower limb salvage) and 30 providers with at least 2 years\u2019 experience caring for SMs with similar injuries participated separately in either a SM or provider\/clinician focus group. Open-ended questions on factors influencing RTD and other rehabilitation success were discussed. Data analysis consisted of qualitative transcription and participatory active sorting, followed by thematic coding and grouping of qualitative data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Individual (health condition, personal traits, and career consideration), interpersonal (clinician\u2019s impact, family influence, and peer influence), health care system (systems of care, transdisciplinary rehabilitation, and innovation availability), and institutional (policy, benefits, and unit\/commander) themes emerged amongst SM patients and clinicians. Expected frequently occurring themes common to both groups were the influence of the team and family unit, as well as career trajectory options after a severe injury. An unexpected theme was acknowledgment of and dissatisfaction with the recent dismantling of institutional systems that support wounded SMs. Patients placed less emphasis on severity of injury and greater emphasis on system and policy barriers than did clinicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Characterization and classification of these clinician and SM-identified factors that influence the decision to RTD after severe lower extremity trauma is expected to improve the efficacy of future rehabilitation efforts and clinical practice guidelines by providing the clinical team the knowledge necessary to recognize modifiable barriers to patient success. A better understanding of factors influencing RTD decision-making may support policies for mitigating RTD barriers, better monitoring of the changing landscape of RTD after lower extremity trauma, improving systems of health care, and\/or reducing turnover and facilitating force readiness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa350","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T01:52:15Z","timestamp":1611625935000},"page":"430-439","source":"Crossref","is-referenced-by-count":4,"title":["Should I Stay or Should I Go? Identifying Intrinsic and Extrinsic Factors in the Decision to Return to Duty Following Lower Extremity Injury"],"prefix":"10.1093","volume":"186","author":[{"given":"Jonathan B","family":"Wilson","sequence":"first","affiliation":[{"name":"Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA"},{"name":"The Center for Rehabilitation Sciences Research, Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher A","family":"R\u00e1bago","sequence":"additional","affiliation":[{"name":"Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA"},{"name":"The Center for Rehabilitation Sciences Research, Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Ft. Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie W","family":"Hoppes","sequence":"additional","affiliation":[{"name":"Army-Baylor University DPT Program, Ft. Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phaidra L","family":"Harper","sequence":"additional","affiliation":[{"name":"Sentier Strategic Resources, Austin, TX 78701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Gao","sequence":"additional","affiliation":[{"name":"Sentier Strategic Resources, Austin, TX 78701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Russell Esposito","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Ft. Sam Houston, TX 78234, USA"},{"name":"Center for Limb Loss and Mobility, Seattle, WA 98108, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"issue":"4","key":"2021012914050051400_R1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/BOT.0b013e31819dfa04","article-title":"Resource utilization and disability outcome assessment of combat casualties from Operation IRAQI Freedom and Operation Enduring Freedom","volume":"23","author":"Masini","year":"2009","journal-title":"J Orthop Trauma"},{"issue":"1","key":"2021012914050051400_R2","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/BOT.0b013e31821c0ec1","article-title":"Return to duty after type III open tibia fracture","volume":"26","author":"Cross","year":"2012","journal-title":"J Orthop Trauma"},{"issue":"2","key":"2021012914050051400_R3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1093\/milmed\/160.2.82","article-title":"Amputee soldiers and their return to active duty","volume":"160","author":"Kishbaugh","year":"1995","journal-title":"Mil Med"},{"issue":"6","key":"2021012914050051400_R4","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1097\/TA.0b013e3181bb9a6c","article-title":"Return to duty rate of amputee soldiers in the current conflicts in Afghanistan and Iraq","volume":"68","author":"Stinner","year":"2010","journal-title":"J Trauma"},{"issue":"S4","key":"2021012914050051400_R5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.7205\/MILMED-D-16-00279","article-title":"The Extremity Trauma and Amputation Center of Excellence: overview of the Research and Surveillance Division","volume":"181","author":"Rabago","year":"2016","journal-title":"Mil Med"},{"issue":"10 Suppl","key":"2021012914050051400_R6","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1016\/j.apmr.2010.12.046","article-title":"Traumatic brain injury patient-reported outcome measure: identification of health-related quality-of-life issues relevant to individuals with traumatic brain injury","volume":"92","author":"Carlozzi","year":"2011","journal-title":"Arch Phys Med Rehabil"},{"issue":"9711","key":"2021012914050051400_R7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S0140-6736(09)61797-9","article-title":"Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study","volume":"375","author":"Cohen","year":"2010","journal-title":"Lancet"},{"issue":"8","key":"2021012914050051400_R8","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1089\/neu.2017.5141","article-title":"A retrospective study of predictors of return to duty versus medical retirement in an active duty military population with blast-related mild traumatic brain injury","volume":"35","author":"Cook","year":"2018","journal-title":"J Neurotrauma"},{"issue":"11 Suppl","key":"2021012914050051400_R9","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1097\/TA.0b013e3182218fbc","article-title":"Rehospitalization after combat injury","volume":"71","author":"Masini","year":"2011","journal-title":"J Trauma"},{"issue":"4","key":"2021012914050051400_R10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.injury.2017.02.019","article-title":"Return to duty following combat-related multi-ligamentous knee injury","volume":"48","author":"Barrow","year":"2017","journal-title":"Injury"},{"issue":"4","key":"2021012914050051400_R11","first-page":"312","article-title":"Return to duty in military members following surgical treatment of incomplete femoral neck fractures","volume":"27","author":"Griffis","year":"2018","journal-title":"J Surg Orthop Adv"},{"issue":"8","key":"2021012914050051400_R12","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1093\/milmed\/163.8.536","article-title":"Spine fractures in active duty soldiers and their return to duty rate","volume":"163","author":"Islinger","year":"1998","journal-title":"Mil Med"},{"issue":"Supp 1","key":"2021012914050051400_R13","first-page":"S1","article-title":"Battlefield orthopaedic injuries cause the majority of long-term disabilities","volume":"19","author":"Cross","year":"2011","journal-title":"Am Acad Orthop Surg"},{"issue":"1 Suppl","key":"2021012914050051400_R14","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1097\/TA.0b013e318221181d","article-title":"Infectious complications and soft tissue injury contribute to late amputation after severe lower extremity trauma","volume":"71","author":"Huh","year":"2011","journal-title":"J Trauma"},{"issue":"1 Suppl","key":"2021012914050051400_R15","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1097\/TA.0b013e3182219225","article-title":"Return to running and sports participation after limb salvage","volume":"71","author":"Owens","year":"2011","journal-title":"J Trauma"},{"issue":"2 Suppl 1","key":"2021012914050051400_R16","doi-asserted-by":"crossref","first-page":"S112","DOI":"10.1097\/TA.0b013e3182606291","article-title":"Deployment after limb salvage for high-energy lower-extremity trauma","volume":"73","author":"Patzkowski","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"8","key":"2021012914050051400_R17","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.injury.2014.02.008","article-title":"Initial injury severity and social factors determine ability to deploy after combat-related amputation","volume":"45","author":"Krueger","year":"2014","journal-title":"Injury"},{"key":"2021012914050051400_R18","volume-title":"Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions","author":"Martin","year":"2012"},{"issue":"3","key":"2021012914050051400_R19","first-page":"315","article-title":"Opportunities for CAT applications in medical rehabilitation: development of targeted item banks","volume":"11","author":"Kisala","year":"2010","journal-title":"J Appl Meas"},{"key":"2021012914050051400_R20","volume-title":"Health Behavior: Theory, Research, and Practice","author":"Sallis","year":"2015"},{"issue":"3","key":"2021012914050051400_R21","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/1090198111418634","article-title":"Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions","volume":"39","author":"Golden","year":"2012","journal-title":"Health Educ Behav"},{"key":"2021012914050051400_R22","first-page":"187","volume-title":"Six Theories of Child Development: Revised Formations and Current Issues","author":"Bronfenbrenner","year":"1992"},{"issue":"1","key":"2021012914050051400_R23","first-page":"8","article-title":"Can an ankle-foot orthosis change hearts and minds?","volume":"20","author":"Patzkowski","year":"2011","journal-title":"J Surg Orthop Adv"},{"issue":"11","key":"2021012914050051400_R24","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1002\/oby.22619","article-title":"The new Army Combat Fitness Test: an opportunity to improve recruitment and retainment","volume":"27","author":"Bigelman","year":"2019","journal-title":"Obesity (Silver Spring)"},{"issue":"10","key":"2021012914050051400_R25","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1007\/s11999-014-3609-7","article-title":"Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma?","volume":"472","author":"Bedigrew","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"2021012914050051400_R26","doi-asserted-by":"crossref","first-page":"507","DOI":"10.2106\/JBJS.K.00254","article-title":"Comparative effect of orthosis design on functional performance","volume":"94","author":"Patzkowski","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"8","key":"2021012914050051400_R27","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1682\/JRRD.2014.06.0141","article-title":"Does unilateral transtibial amputation lead to greater metabolic demand during walking?","volume":"51","author":"Russell Esposito","year":"2014","journal-title":"J Rehabil Res Dev"},{"issue":"1","key":"2021012914050051400_R28","first-page":"50","article-title":"Advanced rehabilitation techniques for the multi-limb amputee","volume":"21","author":"Harvey","year":"2012","journal-title":"J Surg Orthop Adv"},{"key":"2021012914050051400_R29","first-page":"39","article-title":"Center for the intrepid: providing patients POWER","author":"Amorelli","year":"2016","journal-title":"US Army Med Dep J"},{"issue":"Suppl 3","key":"2021012914050051400_R30","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1097\/BOT.0000000000000672","article-title":"Comprehensive rehabilitation following combat extremity trauma: evolution and its impact on outcomes","volume":"30","author":"Rivera","year":"2016","journal-title":"J Orthop Trauma"},{"issue":"8","key":"2021012914050051400_R31","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/BOT.0000000000001493","article-title":"Validation of PROMIS physical function instruments in patients with an orthopaedic trauma to a lower extremity","volume":"33","author":"Rothrock","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"1","key":"2021012914050051400_R32","doi-asserted-by":"crossref","first-page":"e1658","DOI":"10.7205\/MILMED-D-16-00072","article-title":"Functional capacity evaluation\u2013military: program description and case series","volume":"182","author":"Cancio","year":"2017","journal-title":"Mil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/430\/36145138\/usaa350.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/430\/36145138\/usaa350.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T14:07:05Z","timestamp":1611929225000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/Supplement_1\/430\/6119433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,1]]},"references-count":32,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,1,25]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa350","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,1]]},"published":{"date-parts":[[2021,1,1]]}}}