{
  "abstract": "Objectives Over 600 UK Armed Forces personnel and civilians were seriously injured in the conflict in Afghanistan. We examined whether combat injury, and limb loss specifically, reduced the likelihood of employment after leaving the UK Armed Forces and to what extent this was mediated by pain and mobility.Methods Combat-injured participants who were aeromedically evacuated to a UK hospital while on deployment to Afghanistan and subsequently left the UK Armed Forces (n=406) and a comparison group of uninjured personnel who had left the military (n=107) were drawn from an existing cohort (the ADVANCE study). Current employment was determined by self-report questionnaire, and pain and mobility mediating variables were taken from the EuroQol EQ-5D 5-Level measure.Results 21.2% of the injured group were not in paid employment, compared with 14.3% of the uninjured comparison group; this difference was not statistically significant. Unmediated analyses showed that although those with amputation injuries had an increased risk of being unemployed compared with the comparison group, this was not statistically significant. For those who were injured without limb loss, compared with the comparison group, there were indirect effects on employment through both mobility (adjusted risk ratio (aRR) 1.32, 95% CI 1.11 to 1.69) and pain (aRR 1.10, 95% CI 1.01 to 1.31).Conclusions In this severely injured cohort, combat injury does not result in a significantly reduced rate of post-military employment. Any potential relationship between injury and employment for those injured without limb loss compared with the uninjured is due in part to the mediating effects of mobility and pain.",
  "authors": [
    {
      "affiliations": [
        "King’s Centre for Military Health Research, King’s College London, London, UK"
      ],
      "name": "Howard Burdett"
    },
    {
      "affiliations": [
        "Imperial College London, London, UK"
      ],
      "name": "Susie Schofield"
    },
    {
      "affiliations": [
        "King’s Centre for Military Health Research, King’s College London, London, UK"
      ],
      "name": "Daniel Mark Dyball"
    },
    {
      "affiliations": [
        "Imperial College London, London, UK",
        "Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK"
      ],
      "name": "Alexander Bennett"
    },
    {
      "affiliations": [
        "Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK"
      ],
      "name": "Christopher Boos"
    },
    {
      "affiliations": [
        "Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK"
      ],
      "name": "Anthony Bull"
    },
    {
      "affiliations": [
        "King’s Centre for Military Health Research, King’s College London, London, UK",
        "Academic Department of Military Mental Health, King’s College London, London, UK"
      ],
      "name": "Nicola T Fear"
    }
  ],
  "title": "Relationships between combat injury, pain, mobility and post-service employment: the ADVANCE study",
  "uid": "5a469d29-d938-566f-b34e-7baf14b0ee43"
}