{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:26:59Z","timestamp":1787009219536,"version":"build-2736575974"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"7-8","funder":[{"name":"Center for Rehabilitation Science Research, Department of Rehabilitation Medicine, Uniformed Services University","award":["HU0001-11-1-0004, HU0001-15-2-0003."],"award-info":[{"award-number":["HU0001-11-1-0004, HU0001-15-2-0003."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality\u2013based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>As part of an institutional review board\u2013approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and \u223c3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaa483","type":"journal-article","created":{"date-parts":[[2020,12,6]],"date-time":"2020-12-06T23:00:53Z","timestamp":1607295653000},"page":"e777-e783","source":"Crossref","is-referenced-by-count":7,"title":["Inclusion of a Military-specific, Virtual Reality\u2013based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma"],"prefix":"10.1093","volume":"186","author":[{"suffix":"PhD","given":"Riley C","family":"Sheehan","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA"},{"name":"Henry M. 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Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"},{"name":"Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M","family":"Wilken","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A","family":"R\u00e1bago","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA"},{"name":"Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"issue":"1","key":"2021070110334534200_R1","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1016\/j.amepre.2009.10.004","article-title":"A process to identify military injury prevention priorities based on injury type and limited duty days","volume":"38","author":"Ruscio","year":"2010","journal-title":"Am J Prev Med"},{"issue":"3","key":"2021070110334534200_R2","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.gaitpost.2015.02.008","article-title":"Mediolateral angular momentum changes in persons with amputation during perturbed walking","volume":"41","author":"Sheehan","year":"2015","journal-title":"Gait Posture"},{"issue":"5","key":"2021070110334534200_R3","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.jbiomech.2013.12.011","article-title":"Margins of stability in young adults with traumatic transtibial amputation walking in destabilizing environments","volume":"47","author":"Beltran","year":"2014","journal-title":"J Biomech"},{"key":"2021070110334534200_R4","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_4","key":"2021070110334534200_R5","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7205\/MILMED-D-16-00280","article-title":"Outcomes associated with the Intrepid Dynamic Exoskeletal Orthosis (IDEO): a systematic review of the literature","volume":"181","author":"Highsmith","year":"2016","journal-title":"Mil Med"},{"issue":"24","key":"2021070110334534200_R6","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1056\/NEJMoa012604","article-title":"An analysis of outcomes of reconstruction or amputation after leg-threatening injuries","volume":"347","author":"Bosse","year":"2002","journal-title":"N Engl J Med"},{"issue":"8","key":"2021070110334534200_R7","first-page":"1801","article-title":"Long-term persistence of disability following severe lower-limb trauma. 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