Blast Injuries, Polytrauma
Conditions
Brief summary
The goal of this study was to train OIF/OIF Veterans with multiple injuries to be Peer Visitors, i.e., Volunteers who visit more recently OIF/OEF Veterans and provide support. We evaluated the effectiveness of the training, and any benefits that Volunteer Peer Visitors and the Recipients of Peer Visitors experienced as a result of participating in Peer Visitation.
Detailed description
Peer visitation (PV) provides individuals newly dealing with a particular injury/ illness with an opportunity to interact with a peer who has successfully managed a similar condition. Interaction with a successful role model can provide credible social support and information, increase self-efficacy and teach coping strategies, which in turn can engender hope and motivation to engage in treatment and use active coping strategies. In spite of the widespread clinical availability of PV programs, the amount and type of training and clinical/organizational varies widely, and empirical support for their efficacy is limited. The main objective of this project is to test the feasibility of implementing a PV program for OEF/OIF veterans with war-related polytrauma. The proposed study represented a unique opportunity to evaluate three important aspects of peer visitation among OEF/OIF Veterans. Our three hypotheses were: H 1: Veteran Peer Visitors (VPVs) who complete the training will demonstrate successful acquisition of efficacy, knowledge and skills as measured by: (1) pre- and post-tests administered before and after the training; (2) trainer evaluations upon completion of the training, (3) self-evaluation of at least two actual peer visits, and (4) evaluation by two individuals who receive peer visits. H2: VPVs who complete the study will demonstrate increased self-care, improved mood, and increased post-traumatic growth compared to pre-training baseline measures. H 3: Veterans who receive a visit from a VPV will endorse improvement in one or more of the following areas: stress, self-efficacy, activation, mood, ability to make meaning of their experiences, and knowledge of coping options. We used a mixed-methods study to evaluate the feasibility of PV training materials developed in a previous grant to certify 12-18 Veteran Peer Visitors (VPVs). In a prior project, the proposed research team developed the training materials to be tested in this feasibility study, including screening tools to identify appropriate candidates for VPV training, an Instructor manual and a Veteran PV workbook. Two types of participants: Veteran Peer Visitors and Recipients of VPVs were recruited via the Polytrauma Network Site in VISN 20 (Seattle). VPVs were nominated by a clinician to participate and, if enrolled, will undergo 2-day training and will be required to pass a test upon completion of training. Training included a VA Voluntary Services background check, and orientation to the VHA and VA privacy policies. VPVs became official VA volunteers. Each certified VPV was required to provide 1-5 visits to at least two Veterans. Both VPVs and recipients of VPV completed surveys at baseline and upon study completion.
Interventions
OTHERPeer Visitation
Trained Volunteers will visit OEF/OIF Veterans with Polytrauma Injuries to provide support.
Sponsors
US Department of Veterans Affairs
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
For Peer Visitors: * eligibility will be determined using a combination of self-assessment, clinician recommendation, and Voluntary Services screening For participants who are interested in receiving a peer visitor: * eligibility will be determined by the referring clinical team and the Research Nurse Peer Visitors: To be eligible to participate in the study as a potential Veteran Peer Visitor, Veterans must complete several screening steps. A Veteran must be nominated by a clinician from the Center for Polytrauma Care (CPC) Clinical Team, or they must nominate themselves for the project and seek endorsement from a clinician on the CPC team. To be nominated or endorsed by a clinician, the Veteran must have been observed by the clinical team member to demonstrate the following specific behaviors and characteristics: * Reliable and organized about keeping appointments (80% adherence or better) * Demonstrate excellent insight into own treatment goals, progress, barriers, treatment rationale * Not demonstrate any high-risk behaviors in the previous 12 months, including suicidal ideation or intent, inpatient psychiatric treatment (other than planned, voluntary admission to Evaluation and Brief Treatment Unit), active substance abuse or dependence, uncontrolled psychotic symptoms (e.g., hallucinations, delusions), felonies. * Evidence of good social support (i.e., clinician aware of supportive relationships) * Engaged in meaningful life goals and activities (e.g., work, school, volunteering, parenting, recreation, church) * Able to pass background check for Voluntary Services * Must be English Speaking * Able to complete pen and paper surveys
Exclusion criteria
* Not an OEF/OIF Veteran * Under age 18 * Non English Speaking * Psychiatrically at risk (i.e., uncontrolled psychotic symptoms, active substance abuse or dependence)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post Traumatic Growth Inventory | Upon completion of study requirements (i.e., visits) | Administered only to Peer Visitors, possible range 0-105, with higher scores indicating greater post-traumatic growth. Post-traumatic growth includes emotional changes such as noticing a stronger sense of self, deepened relationships, increased sense of gratitude or appreciation for life, increased spirituality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Health Questionnaire-9 (Depression Screen) | Upon completion of visits. | 9-item depression screen with possible response options ranging from 9-36, with higher numbers indicating greater depression symptom severity. |
| Post-Traumatic Stress Disorder Checklist- Military Version (PCL-M) | Upon study completion. | Measures PTSD symptoms. Possible scores range from 19-95, with higher scores indicating greater symptom severity. |
| Patient Activation Measure | Post- Participation | Measures participante self-efficacy, knowledge of and engagement in health care. Possible scores range from 13-52 with higher scores indicating greater efficacy/knowledge/engagement. |
| General Anger Level | Post- Participation | 5-item scale developed for this study. Assesses level of perceived experienced anger in the past month. Possible scores range from 5-35 with higher scores indicating greater levels of anger. |
Countries
United States
Participant flow
Recruitment details
Both types of study participants were recruited from Veterans who were seen in Polytrauma Clinics at the Polytrauma Network Site. Both types of participants were referred by clinicians based on their clinical knowledge of whether this intervention seemed indicated; Recipients could also self-refer based on printed information.
Pre-assignment details
400 Veterans were considered by the interdisciplinary polytrauma team as candidates for PV training. Of these, 29 (7%) were nominated. Of these, 14 (48%) were not enrolled: 6 (21%) due to time or travel restrictions, 6 (21%) could not be reached, and 2 (6%) because they had either been injured too recently or not participated in enough therapies.
Participants by arm
| Arm | Count |
|---|---|
| Veteran Peer Visitors Veterans who seved in Operation Iraqi Freedom or Operation Enduring Freedom, sustained polytrauma injuries, and successfully completed rehabiliation were recruited for training as peer mentors. | 14 |
| Recipients of Peer Visitors Veterans who seved in Operation Iraqi Freedom or Operation Enduring Freedom, sustained polytrauma injuries, and were initiating rehabilitation therapies. | 8 |
| Total | 22 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Removed by Investigators; unable to matc | 3 | 0 |
| Overall Study | Withdrawal by Subject | 4 | 1 |
Baseline characteristics
| Characteristic | Recipients of Peer Visitors | Total | Veteran Peer Visitors |
|---|---|---|---|
| Age, Continuous | 36.5 years | 35 years | 34.1 years |
| Patient Activation | 39 units on a scale | NA units on a scale | NA units on a scale |
| Patient Health Questionnaire-9 | 27.4 units on a scale | 18.2 units on a scale | 12 units on a scale |
| Post Traumatic Growth Inventory | NA units on a scale | NA units on a scale | 64.6 units on a scale |
| PTSD check-list (PCL) Military Version | 68 units on a scale | 56 units on a scale | 34 units on a scale |
| Self-Reported Anger | 28.5 units on a scale | NA units on a scale | NA units on a scale |
| Sex: Female, Male Female | 1 Participants | 2 Participants | 1 Participants |
| Sex: Female, Male Male | 7 Participants | 20 Participants | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 15 | 0 / 9 |
| serious Total, serious adverse events | 0 / 15 | 0 / 9 |
Outcome results
Primary
Post Traumatic Growth Inventory
Administered only to Peer Visitors, possible range 0-105, with higher scores indicating greater post-traumatic growth. Post-traumatic growth includes emotional changes such as noticing a stronger sense of self, deepened relationships, increased sense of gratitude or appreciation for life, increased spirituality.
Time frame: Upon completion of study requirements (i.e., visits)
Population: This measure was only administered to Veteran Peer Visitors.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Veteran Peer Visitors | Post Traumatic Growth Inventory | 67.4 units on a scale |
Secondary
General Anger Level
5-item scale developed for this study. Assesses level of perceived experienced anger in the past month. Possible scores range from 5-35 with higher scores indicating greater levels of anger.
Time frame: Post- Participation
Population: This measure was only administered to Recipients of Peer Visits.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Recipients of PV | General Anger Level | 24.8 units on a scale |
Secondary
Patient Activation Measure
Measures participante self-efficacy, knowledge of and engagement in health care. Possible scores range from 13-52 with higher scores indicating greater efficacy/knowledge/engagement.
Time frame: Post- Participation
Population: This measure was only administered to Recipients of Peer Visitation.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Recipients of PV | Patient Activation Measure | 38 units on a scale |
Secondary
Patient Health Questionnaire-9 (Depression Screen)
9-item depression screen with possible response options ranging from 9-36, with higher numbers indicating greater depression symptom severity.
Time frame: Upon completion of visits.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Veteran Peer Visitors | Patient Health Questionnaire-9 (Depression Screen) | 19.4 units on a scale |
| Recipients of PV | Patient Health Questionnaire-9 (Depression Screen) | 23.6 units on a scale |
Secondary
Post-Traumatic Stress Disorder Checklist- Military Version (PCL-M)
Measures PTSD symptoms. Possible scores range from 19-95, with higher scores indicating greater symptom severity.
Time frame: Upon study completion.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Veteran Peer Visitors | Post-Traumatic Stress Disorder Checklist- Military Version (PCL-M) | 44.7 units on a scale |
| Recipients of PV | Post-Traumatic Stress Disorder Checklist- Military Version (PCL-M) | 53.7 units on a scale |