Despite the prevalence of blast-related injuries among returning war veterans there are still big gaps in research into long-term effects, according to a newly released study by the National Academy of Science's Institutes of Medicine (IOM). These gaps exist not only in research into specific injury types, but also in understanding the ways in which blast injuries can involve multiple systems and create "cross system interactions" such as mild traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
The new publication, Long-Term Effects of Blast Exposure (.pdf available for free, login required), is the ninth volume in a series of congressionally mandated studies focusing on the health effects of military service. The newest report focuses on blast injury effects present after 6 months, and is based on reviews of nearly 13,000 titles and abstracts and approximately 400 full peer-reviewed journal articles. The report estimates that between 2001and 2011, more than 31,000 soldiers were injured by explosive devices in the Iraq and Afghanistan wars.
The committee conducting the review focused its efforts on determining what links exist between sustaining a blast and specific health outcomes. Using a classification system developed for previous military health studies, the report group placed various long-term conditions along a range of linkage levels from "sufficient evidence of a causal relationship" to "inadequate/insufficient evidence of an association." The report identified permanent eye injury and damage to genitourinary organs as highly linked, while pulmonary function, vertigo, and exercise limitation were described as insufficiently linked to the initial blast injury.
The report emphasizes that that committee's work was limited by significant gaps in evidence and that any analysis that focuses on one type of injury provides an incomplete picture. "A fundamental feature of exposure to blast is that it can result in complex, multisystem injuries," the report states. "Attention to those complexities has often been lacking in research studies. It is important that research on blast [injuries] emphasize multisystem injury patterns and seek to understand the clinical importance of cross-system interactions."
The report also includes 10 recommendations for further study, mostly directed at the US Department of Defense (DOD) and Veterans Administration (VA). The recommendations focus on the need for further research and longitudinal studies as well as analyses of institutional barriers to collaborative studies, and an investigation into biomarkers of blast injury.
APTA has been a strong advocate for more research into the blast injuries, and offers resources related to the physical therapist and physical therapist assistant role in treatment of blast-related injuries at the association's Management of Wounded Warriors webpage. The association has also been active in the Joining Forces Initiative that highlights the needs and strengths of military families.
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