• Rabeea Maqsood, Susie Schofield, Alexander N Bennett, Ahmed Khattab, Carol Clark, BullAnthony M JAMJCentre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London SW7 2AZ, UK., Nicola T Fear, and Christopher J Boos.
• Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK.
• Mil Med. 2024 Feb 27; 189 (3-4): e758e765e758-e765.

IntroductionCombat-related traumatic injury (CRTI) adversely affects heart rate variability (HRV). The mediating effect of mental and physical health factors on the relationship between CRTI, its severity and HRV has not been previously studied and investigated.Materials And MethodsA cross-sectional mediation analysis of the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study was performed. The sample consisted of injured and uninjured British male servicemen who were frequency-matched based on their age, rank, role-in-theater, and deployment to Afghanistan (2003-2014). CRTI and injury severity (the New Injury Severity Scores [NISS] [NISS < 25 and NISS ≥ 25]) were included as exposure variables. HRV was quantified using the root mean square of successive differences (RMSSD) obtained using pulse waveform analysis. Depression and anxiety mediators were quantified using the Patient Health Questionnaire and Generalized Anxiety Disorder, respectively. Body mass index and the 6-minute walk test (6MWT) represented physical health measures. Two mediation pathways between exposure and outcome variables were examined in comparison with the uninjured group using structural equation modeling.ResultsOf 862 servicemen, 428 were injured and 434 were uninjured with the mean age at assessment of 33.9 ± 5.4 (range 23-59) years. Structural equation modeling revealed that depression, anxiety, and body mass index did not significantly mediate the relationship between injury/injury severity and RMSSD. However, the 6MWT significantly mediated the relationship between CRTI and RMSSD (27% mediation). The indirect effect of 6MWT on the relationship between injury severity (NISS ≥ 25 vs. uninjured) and RMSSD was -0.06 (95% CI: -0.12, -0.00, P < .05).ConclusionsThe findings suggest that greater physical function may improve HRV following CRTI. Longitudinal studies are warranted to further validate these findings.© The Association of Military Surgeons of the United States 2023.

23 keywords...

hide…