Evaluation of the Military Functional Assessment Program: Preliminary Assessment of the Construct Validity Using an Archived Database of Clinical Data.

BACKGROUND: Several important factors must be considered when deciding to return a soldier to duty after a traumatic brain injury (TBI). Premature return increases risk for not only second-impact syndrome during the acute phase but also permanent changes from repetitive concussions. Thus, there is a critical need for return-to-duty (RTD) assessment criteria that encompass the spectrum of injury and disease experienced by US soldiers, particularly TBI. OBJECTIVES: To provide evidence-based standards to eventually serve as criteria for operational competence and performance of a soldier after injury. Specifically, the relationships between clinical assessments and novel military-specific tasks were evaluated. METHOD: Exploratory analyses (including nonparametric tests and Spearman rank correlations) of an archived database. PARTICIPANTS: A total of 79 patients with TBI who participated in an RTD assessment program at a US Army rehabilitation and recovery center. MAIN MEASURES: Military Functional Assessment Program (to determine a soldier's operational competence and performance after TBI) tasks; Dizziness Handicap Inventory; Dynamic Visual Acuity (vestibular function); Sensory Organization Test (postural control); Repeatable Battery for the Assessment of Neuropsychological Status (neuropsychological screening test); Beck Depression Inventory-II; Beck Anxiety Inventory; Comprehensive Trail Making Test (visual search and sequencing); posttraumatic stress disorder checklist military version; Alcohol Use Disorders Identification Test; Epworth Sleepiness Scale; Patient Health Questionnaire; and Military Acute Concussion Evaluation. RESULTS: Selected military operational assessment tasks correlated significantly with clinical measures of vestibular function, psychological well-being, and cognitive function. Differences on occupational therapy assessments, a concussion screening tool, and a self-report health questionnaire were seen between those who passed and those who failed the RTD assessment. Specifically, those who passed the RTD assessment scored more favorably on these clinical assessments. CONCLUSIONS: This study demonstrated convergent validity between Military Functional Assessment Program tasks and clinical assessment scores. The Military Functional Assessment Program shows promise for augmenting decision making related to RTD and soldier skills. Additional research is needed to determine the effectiveness of this program in predicting RTD success.

Visual and flight performance recovery after PRK or LASIK in helicopter pilots.

INTRODUCTION: Refractive surgery, specifically photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), is becoming more accepted in the military environment. Determination of the impact on visual performance in the more demanding aviation environment was the impetus for this study. METHODS: A prospective evaluation of 20 Black Hawk pilots pre-surgically and at 1 wk, 1 mo, and 6 mo postsurgery was conducted to assess both PRK and LASIK visual and flight performance outcomes on the return of aviators to duty. RESULTS: Of 20 pilots, 19 returned to flight status at 1 mo after surgery; 1 PRK subject was delayed due to corneal haze and subjective visual symptoms. Improvements were seen under simulator night and night vision goggle flight after LASIK; no significant changes in flight performance were measured in the aircraft. Results indicated a significantly faster recovery of all visual performance outcomes 1 wk after LASIK vs. PRK, with no difference between procedures at 1 and 6 mo. Low contrast acuity and contrast sensitivity only weakly correlated to flight performance in the early post-operative period. DISCUSSION: Overall flight performance assessed in this study after PRK and LASIK was stable or improved from baseline, indicating a resilience of performance despite measured decrements in visual performance, especially in PRK. More visually demanding flight tasks may be impacted by subtle changes in visual performance. Contrast tests are more sensitive to the effects of refractive surgical intervention and may prove to be a better indicator of visual recovery for return to flight status.