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

Kelley, Amanda M. PhD; Ranes, Bethany M. PhD; Estrada, Art PhD; Grandizio, Catherine M. MS

Journal of Head Trauma Rehabilitation: July/August 2015 - Volume 30 - Issue 4 - p E11–E20
doi: 10.1097/HTR.0000000000000060
Original Articles

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.

Warfighter Health Division, US Army Aeromedical Research Laboratory, Fort Rucker, Alabama (Dr Kelley and Estrada and Ms Grandizio); and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (Dr Ranes). Dr Kelley is now at the National Highway Traffic Safety Administration, Department of Transportation. Ms Grandizio is now at Embry-Riddle Aeronautical University.

Corresponding Author: Amanda M. Kelley, PhD, National Highway Traffic Safety Administration, Department of Transportation, 1200 New Jersey Ave SE, Washington, DC 20590 (

This study was funded by the US Army Medical Research and Materiel Command's (USAMRMC's) Military Operational Medicine Research Program. This research was supported in part by an appointment to the Postgraduate Research Participation Program at the US Army Aeromedical Research Laboratory administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and USAMRMC.

The authors acknowledge the dedication and professionalism of the research staff at the Warrior Resiliency and Recovery Center, Fort Campbell, Kentucky, for their contributions to the success of this project. The opinions, interpretations, conclusions, and recommendations contained in this report are those of the authors and should not be construed as an official Department of the Army position, policy, or decision, unless so designated by other official documentation.

This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research.

The authors declare no conflicts of interest.

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