{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:35:15Z","timestamp":1769157315981,"version":"3.49.0"},"reference-count":37,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Blesma, The Limbless Veterans","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Help for Heroes","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"HM Treasury","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Nuffield Trust for the Forces of the Crown","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"UK Ministry of Defence","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"National Lottery","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Headley Court","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100012345","name":"Forces in Mind Trust","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100012345","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"accepted":{"date-parts":[[2025,10,13]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Over 600 UK Armed Forces personnel and civilians were seriously injured in the conflict in Afghanistan. We examined whether combat injury, and limb loss specifically, reduced the likelihood of employment after leaving the UK Armed Forces and to what extent this was mediated by pain and mobility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Combat-injured participants who were aeromedically evacuated to a UK hospital while on deployment to Afghanistan and subsequently left the UK Armed Forces (n=406) and a comparison group of uninjured personnel who had left the military (n=107) were drawn from an existing cohort (the ADVANCE study). Current employment was determined by self-report questionnaire, and pain and mobility mediating variables were taken from the EuroQol EQ-5D 5-Level measure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>21.2% of the injured group were not in paid employment, compared with 14.3% of the uninjured comparison group; this difference was not statistically significant. Unmediated analyses showed that although those with amputation injuries had an increased risk of being unemployed compared with the comparison group, this was not statistically significant. For those who were injured without limb loss, compared with the comparison group, there were indirect effects on employment through both mobility (adjusted risk ratio (aRR) 1.32, 95% CI 1.11 to 1.69) and pain (aRR 1.10, 95% CI 1.01 to 1.31).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this severely injured cohort, combat injury does not result in a significantly reduced rate of post-military employment. Any potential relationship between injury and employment for those injured without limb loss compared with the uninjured is due in part to the mediating effects of mobility and pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/oemed-2025-110328","type":"journal-article","created":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T18:20:16Z","timestamp":1763922016000},"page":"521-526","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Relationships between combat injury, pain, mobility and post-service employment: the ADVANCE study"],"prefix":"10.1136","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8127-8981","authenticated-orcid":false,"given":"Howard","family":"Burdett","sequence":"first","affiliation":[{"name":"King\u2019s Centre for Military Health Research, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susie","family":"Schofield","sequence":"additional","affiliation":[{"name":"Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-8674","authenticated-orcid":false,"given":"Daniel Mark","family":"Dyball","sequence":"additional","affiliation":[{"name":"King\u2019s Centre for Military Health Research, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Bennett","sequence":"additional","affiliation":[{"name":"Imperial College London, London, UK"},{"name":"Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Boos","sequence":"additional","affiliation":[{"name":"Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Bull","sequence":"additional","affiliation":[{"name":"Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5792-2925","authenticated-orcid":false,"given":"Nicola T","family":"Fear","sequence":"additional","affiliation":[{"name":"King\u2019s Centre for Military Health Research, King\u2019s College London, London, UK"},{"name":"Academic Department of Military Mental Health, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"key":"2026012122551544000_82.11.521.1","unstructured":"Dempsey N . Research briefing: Afghanistan statistics: UK deaths, casualties, mission costs and refugees. London, UK: House of Commons Library, 2021."},{"key":"2026012122551544000_82.11.521.2","unstructured":"Ministry of Defence . Annual tracking of Afghanistan very seriously injured\/seriously injured UK operational casualties 8 October 2007-30 September 2015. 2007."},{"key":"2026012122551544000_82.11.521.3","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000580"},{"key":"2026012122551544000_82.11.521.4","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.injury.2017.05.022","article-title":"Extremity injuries sustained by the UK military in the Iraq and Afghanistan conflicts: 2003-2014","volume":"48","author":"Chandler","year":"2017","journal-title":"Injury"},{"key":"2026012122551544000_82.11.521.5","unstructured":"Ministry of Defence . Annual medical discharges in the UK regular armed forces: 1 April 2017 to 31 March 2022. London, UK, 2017."},{"key":"2026012122551544000_82.11.521.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmilitary-2020-001759"},{"key":"2026012122551544000_82.11.521.7","unstructured":"Burdett H , Verey A , Fear NT . Overview of literature on transition outcomes of battlefield injuries. King\u2019s Centre for Military Health Research; 2023."},{"key":"2026012122551544000_82.11.521.8","doi-asserted-by":"publisher","DOI":"10.1080\/09638280110105213"},{"key":"2026012122551544000_82.11.521.9","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2001.18231"},{"key":"2026012122551544000_82.11.521.10","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3233\/JVR-180923","article-title":"Operation Enduring Freedom and Operation Iraqi Freedom Veterans with amputation: An exploration of resilience, employment and individual characteristics","volume":"48","author":"Armstrong","year":"2018","journal-title":"J Vocat Rehabil"},{"key":"2026012122551544000_82.11.521.11","doi-asserted-by":"publisher","DOI":"10.1177\/0309364610397087"},{"key":"2026012122551544000_82.11.521.12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/kykl.12319","article-title":"Is pain associated with subsequent job loss? 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