Seth Messinger, Sayeh Bozorghadad, Paul Pasquina
Center for Rehabilitation Sciences Research, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 20814 Bethesda, USA. E-mail: seth.messinger.ctr@usuhs.edu
DOI: 10.2340/16501977-2274

Objective: To explore how the social context of the clinic influenced the way former patients with lower limb loss in the Military Advanced Training Center at Walter Reed National Military Medical Center evaluated their outcomes.
Design: Cross-sectional phenomenological-based interviews and observations.
Patients: Twenty individuals with lower limb amputation were recruited from a multidisciplinary military treatment programme for patients with lower-extremity traumatic limb-loss injured in Afghanistan or Iraq.
Methods: Lightly structured interviews were conducted either in person or over the telephone with former patients and clinical care-providers. Where possible, observation was conducted in conjunction with the interviews. The research team used content analysis of the data, consistent with ethnographic methods.
Results: Analysis of the therapeutic effect of social relationships developed in the clinical rehabilitation programme identified 3 areas of significance: enduring relationships with key care-providers, access to treatment team by patients, and peer support among patients.
Conclusion: The social component of service delivery influences patients’ outcomes from clinical care. These results could be translated across healthcare settings to improve patient outcomes.

In this article we discuss twenty former patients in a military outpatient physical rehabilitation program for service members with war related traumatically acquired limb amputations. These twenty former patients have all received care and are now living in the community. They describe their lives as being currently successful in terms of work, family, and community living. The main question posed in the lengthy interviews for this study is what role the rehabilitation program at the military hospital played, if any, in the former patients’ understanding of their current success.
These former patients described three features of the hospital program that they attribute to making a strong contribution to their current success. These were the psychological and social support they derived from the strong relationships they developed with their physical and occupational therapists, the routine meetings they had with their entire treatment team, and being able to recover alongside peers with similar injuries.
These three features of the program, long relationships with important care providers, access to the whole treatment team, and recovering alongside peers can be replicated in other medical settings that may not be as wealthy in biotechnology as are US based military hospitals.