Findings and Publications

Published key findings from the ADVANCE baseline data are summarised below. Full publications and summaries of the key publications can be found further down the page.

Summary of the key findings from the ADVANCE baseline data to date:

  • Cardiovascular risk was found to be slightly increased in the injured cohort compared to the uninjured cohort, but the differences are not big enough to warrant any medical treatment at this stage.
  • The injured non-amputees were found to have greater rates of depression, anxiety and post-traumatic stress disorder (PTSD) compared to those with amputations and the uninjured participants. Participants with amputations and the uninjured participants reported similar rates of mental health issues.
  • The participants with amputations reported greater rates of post-traumatic growth (PTG) compared to the injured non-amputees and the uninjured group. Pain was associated with a higher likelihood of reporting PTG.
  • Lower bone mineral density was seen in the hip of the amputated side of participants with amputation injuries compared to the rest of the cohort. No other significant differences in bone health were seen within the cohort.
  • Heart rate variability (HRV) was found to be lower in the injured group compared to the uninjured group.

Full articles

  1. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study (BMJ Open, Sept 2020)
  2. Association between combat-related traumatic injury and cardiovascular risk (Heart, Nov 2021)
  3. Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study (Lancet Psychiatry, July 2022)
  4. Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study (Psychological Medicine, Aug 2022)
  5. Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis (PLOS ONE, Jan 2023)
  6. The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study (Journal of Psychiatric Research, March 2023)
  7. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study (BMJ Military Health, March 2023)
  8. Association Between Combat-Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study (Journal of Bone and Mineral Research, May 2023)
  9. The Relationship between Combat-related Traumatic Amputation and Subclinical Cardiovascular Risk (International Journal of Cardiology, July 2023)
  10. The Influence of Physical and Mental Health Mediators on the Relationship Between Combat-Related Traumatic Injury and Ultra-Short-Term Heart Rate Variability in a U.K. Military Cohort: A Structural Equation Modeling Approach (Military Medicine, Sept 2023)
  11. Reliability of carotid-femoral arterial waveforms for the derivation of ultra-short term heart rate variability in injured British servicemen: An inter-rater reliability study (PLOS One, Sept 2023)
  12. Pain after combat injury in male UK military personnel deployed to Afghanistan (British Journal of Anaesthesia, Mar 2024)

Summaries of publications

  1. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study

2. Association between combat-related traumatic injury and cardiovascular risk

3. Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study

4. Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study

6. The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study

7. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

8. Association Between Combat-Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study

9. The Relationship between Combat-related Traumatic Amputation and Subclinical Cardiovascular Risk

10. The Influence of Physical and Mental Health Mediators on the Relationship Between Combat-Related Traumatic Injury and Ultra-Short-Term Heart Rate Variability in a U.K. Military Cohort: A Structural Equation Modeling Approach

12. Pain after combat injury in male UK military personnel deployed to Afghanistan

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