Relationships between combat injury, pain, mobility and post-service employment: the ADVANCE study

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.

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.

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).

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.