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The objective of this research was to develop and pilot a computer-based self-management (SM) program (the Next Steps Program) for reducing secondary conditions and improving function following major lower limb trauma. The intervention builds on widely accepted SM programs developed for persons with arthritis as well as components of a face-toface SM program for civilians with long-standing limb loss. It was necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely-injured population. The program consists of three overall components: 12 narrated, interactive Flash lessons; telephone and web-based support services (including weekly facilitated online chats; and access to online resources. A website (www.nextstepsonline.org) provides access to the lessons, support services and online resources. Results of the pilot study (n=30 civilian trauma patients) indicate high satisfaction with the program and participants report having benefitted from Next Steps. Preliminary data suggest that outcomes are positively impacted by the program. Computer-based self-management programs for the acutely-injured will provide a much-needed adjunct to the orthopaedic care now available and contribute to a comprehensive trauma would provide injured soldiers with an ongoing mechanism of support as they transition from inpatient rehabilitation to the ma management program to improve longterm outcomes and quality of life. A military version of the Next Steps program community - whether that be in the military or civilian sectors.

The objective of this research is to develop and pilot a computer-based self management program (heretofore referred to as the NextSteps Program) for reducing secondary conditions and improving function following major lower limb trauma. The intervention was built on widely accepted self-management programs developed for persons with arthritis as well as components of a face-to-face self-management program for civilians with long-standing limb loss. It was necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely injured population. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), and the maintenance or acquisition of employment or return to active duty. Specific aims (revised in April 2009) of the project are: (1) to pilot the face-to-face self-management program for persons sustaining major limb trauma and refine the intervention based on feedback; (2) to develop on online version of the self-management program for persons sustaining major limb trauma (heretofore referred to as Next Steps); (3) to evaluate the feasibility and acceptability of the Next Steps program in 12-15 civilians treated at a large, Level I trauma center; and (4) to engage our military colleagues and service members as advisors to assist us in modifying the content of the Next Steps Program for service members and veterans. We will not have sufficient funds remaining at the end of the project period to fully develop and test the military version of NextSteps at Walter Reed as originally planned. However, we will produce a detailed plan for modifying the program in the future., The original document contains color images.

It is estimated that there have been several hundred tibia fractures that have occurred in the global war on terror. Little is known about the long-term consequences of these injuries and their treatment. Objective: Our main objective is to determine significant predictors of poor outcome following open tibia fractures so that suitable modifications can be made to treatment and rehabilitative therapy. Of particular interest is an evaluation of differences in outcomes for various algorithms for the treatment of open tibia fractures. Specific Aims: We aim to: (1) describe the long term consequences of open tibia fractures; (2) identify clinical and patient characteristics that explain variations in outcome; and (3) make recommendations for treatment adjustments. Study Design: Patients will be identified retrospectively. The retrospective cohort (numbering approximately 430) will consist of all soldiers who meet the inclusion criteria and were injured as of September 30, 2006 and cared for at one of the participating facilities. Principal sources of data will include: (1) clinical data abstracted from the medical record; (2) baseline interviews; and (3) a follow-up interview one-year following the baseline interview. Relevance: This long term follow-up will provide a unique opportunity to (1) examine the benefits of different treatment modalities for open tibia fractures in a military population; (2) identify ongoing needs for additional services; (3) provide the basis for targeted interventions; and (4) assist in assuring that these and future soldiers are provided with every opportunity for a good long-term outcome.

The objective of this research is to develop and evaluate the efficacy of a computer-based self management program (heretofore referred to as NextSteps Program) for reducing secondary conditions and improving function following major lower limb trauma. The intervention will build on widely accepted self-management programs developed for persons with arthritis as well as components of a face-to-face self-management program for civilians with long-standing limb loss. It will be necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely injured population. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), and the maintenance or acquisition of employment or return to active duty. If shown to be efficacious, computer based self management programs for the acutely injured will provide a much-needed adjunct to the orthopedic care now available and contribute to a comprehensive trauma management program to improve long-term outcomes and quality of life. The military version of SM program will provide injured soldiers with an ongoing mechanism of support as they transition from inpatient rehabilitation to the community - whether that be in the military or civilian sectors., The original document contains color images.

The objective of this research is to develop and evaluate the efficacy of a computer-based self management program (heretofore referred to as NextSteps Program) for reducing secondary conditions and improving function following major lower limb trauma. The intervention will build on widely accepted self-management programs developed for persons with arthritis as well as components of a face-to-face self-management program for civilians with long-standing limb loss. It will be necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely injured population. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), and the maintenance or acquisition of employment or return to active duty. If shown to be efficacious, computer based self management programs for the acutely injured will provide a much-needed adjunct to the orthopedic care now available and contribute to a comprehensive trauma management program to improve long-term outcomes and quality of life. The military version of SM program will provide injured soldiers with an ongoing mechanism of support as they transition from inpatient rehabilitation to the community - whether that be in the military or civilian sectors., The original document contains color images.

The objective of this research is to develop and evaluate the efficacy of a computer-based self management program (heretofore referred to as NextSteps Program) for reducing secondary conditions and improving function following major lower limb trauma. The intervention will build on widely accepted self-management programs developed for persons with arthritis as well as components of a face-to-face self-management program for civilians with long-standing limb loss. It will be necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely injured population. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), and the maintenance or acquisition of employment or return to active duty. If shown to be efficacious, computer based self management programs for the acutely injured will provide a much-needed adjunct to the orthopedic care now available and contribute to a comprehensive trauma management program to improve long-term outcomes and quality of life. The military version of SM program will provide injured soldiers with an ongoing mechanism of support as they transition from inpatient rehabilitation to the community -- whether that be in the military or civilian sectors.

The objective of this research is to develop and evaluate the efficacy of a computer-based self management program (heretofore referred to as OSMP-T) for reducing secondary conditions and improving function following major lower limb trauma. The intervention will build on widely accepted self-management programs developed for persons with arthritis as well as components of a faceto- face self-management program for civilians with long-standing limb loss. It will be necessary, however, to tailor the content and delivery of these programs to better accommodate the needs of a young, acutely injured population. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), and the maintenance or acquisition of employment or return to active duty. The specific aims of the proposed study are three-fold: (1) to develop the OSMP-T; (2) to evaluate the efficacy of the OSMP-T in 225 civilians initially treated at 5 level I trauma centers; and (3) to modify the OSMP-T for application in the military and to pilot the modified program in a smaller group of 24 injured soldiers treated at the Walter Reed Army Medical Center. If shown to be efficacious, computer based self management programs for the acutely injured will provide a much-needed adjunct to the orthopedic care now available and contribute to a comprehensive trauma management program to improve long-term outcomes and quality of life. The military version of SM program will provide injured soldiers with an ongoing mechanism of support as they transition from inpatient rehabilitation to the community whether that be in the military or