ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Allami   M. (1)
Karimi   A. (1)
Janzadeh   N. (1)
Feizollahi   N. (1)
Esfandiari   E. (1)
Masoumi   M. (*)
Ghoseiri   K. (1)
Mousavi   B. (1)
Asgari   M. (1)
Soroush   M. (1)
Ganjparvar   Z. (1)
Yavari   A. (1)
Abdolrahimi Kafi   N. (1)
Rezai Imcheh   A. (1)
Heydari Someeh   A. (1)
Tavwoseh   F. (1)
Shabanian   N. (1)
Nikpour   A. (1)
Mirsadeghi   S.A. (1)
Mohammadnezhad   Gh. (1)
Vali   Z. (1)






(*) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(1) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran

Correspondence

Address: Janbazan Medical and Engineering Research Center (JMERC), No. 17, Farokh Street, Moghadas Ardabili Street, Yaman Street, Shahid Chamran Highway, Tehran, Iran
Phone: +98 (21) 22416699
Fax: +98 (21) 22416699
masoumi48@yahoo.com

Article History

Received:  April  10, 2016
Accepted:  July 4, 2016
ePublished:  August 31, 2016

BRIEF TEXT


… [1-3].About 70% of all war injuries are musculoskeletal injuries and although its morality is very low, the rate of its complication is very high [4, 5].

… [6-9]. After nearly three decades of imposed war of Iraq against Iran, more than 500 thousands veterans with a variety of injuries are supported by Foundation of Martyrs and Veterans Affairs that the significant percent of them have musculoskeletal, ankle and leg disorders [10-11].

The aim of this study was to assess the epidemiological situation of lower limb injuries in veterans with leg and ankle neuro-musculoskeletal disorders as well as the presence of risk factors in this group of veterans.

This is a descriptive and cross-sectional study.

This study was conducted on veterans with leg and ankle neuro-musculoskeletal disorders in 8 centers of Isfahan, Mazandaran, Zanjan, Markazi, West Azarbaijan, Hamedan, Ardebil and Kermanshah provinces during 2013-2015.

This study was conducted on 795 veterans who participated in this study in census form.

Demographic gathering information form include age, gender, marital status, number of children, education, employment status, Being covered by the Employment Act, the percentage of injury, location of injury, the cause and date of injury and the economic status. According to Article 51 of extraordinary payment for sacrifice in Comprehensive Service-Delivery to Veterans Law enacted in July 1995, Disabled veterans with the prediction of organizational posts or jobs in organization of parallel with their previous jobs are considered as employee and in terms of payment and benefits they are treated as the employees in the concerned organizations [12]. Employment is defined as being covered with the law. The satisfaction of the current job, special facilities at work and number of days missed from work due to injury was questioned. The type of leg and ankle neuro-musculoskeletal disorder (right, left or both) including a scope of limitations (ankle dorsiflexion, short limbs, partial amputations, and peripheral injuries in lower limbs) were examined, Also, the number of surgeries in affected leg, accidents resulting in physical injuries during a passing year to the study, hospitalization in hospital and accompanied injuries for each of the participants were recorded. Information was collected on this form by a trained expert in an interview about 10 minutes. Collected data was entered into SPSS 22 software and statistical analysis was performed by a statistician. The results of descriptive statistics were reported in form of frequency and percentage of qualitative data and frequency, percentage, mean and standard deviation for the quantitative variables. In analytic statistics, for investigating the relationship between variables, chi-square test and Pearson Correlation were used. In addition, to compare the quantitative variables between the groups, ANOVA was used. In cases were the data was not normal, Kruskal-Wallis test was used.

The total number of veterans with leg and ankle neuro-musculoskeletal disorders in the studied provinces was around 1500 and the rate of responses was 53.0%. Therefore, 795 veterans participated in the study. Most participants were from West Azerbaijan and Hamedan provinces and the lowest number was belonged to Ardebil Province. The mean age of participants was 52.21±8.01 years (minimum 25 and the maximum of 93 years) and they were almost male. The mean percentage of injuries was 33.88%±15.10 (minimum 5.0% and maximum 70.0%). About 496 (62.4%) had not been married before the injury while almost all of them (98.0%) were married. Before the injury, 249 (30.8%) were studying and 512 (64.4%) were working. This is while, after the injury, one-third (38.9%) were working. 390 (49.1%) of participants were covered by Act Law. The mean of injury duration was 28.67±4.43 years and the mean age at the time of injury was 23.52±7.42 (Table 1). The satisfaction level of the veterans of their current occupation, was high and very high, medium, low and very low in 59 (19.1%), 132(42.7%), and 118(38.2%) of the participants respectively. Only 54 (17.5%) of the participants had special facilities at work. 97 (12.2%) of the participants, during the passing year to the study, had serious injuries (such as fracture and physical injuries) due to movement or doing duties that 47 (48.4%) of them had injured once and 50 (51.5%) had injured twice. Among the employed participants, 65 (21.0%) had to leave the job and rest at home because of the injuries, and 8(12.3%), 11(16.9%), 22 (33.8%), and 24(36.9%) had one week or less, 8 days to two weeks, 15 days to a month, and 2 to 6 months absence from their jobs. In terms of economic status, according to the participants, 254(65.9%), 258(32.4%), and 13 (1.6%) of the participants were in the medium level, low level and high level of economic status respectively. The place of injury for 740(93.1%) of the participants was war zone. The causes of injuries were: Shrapnel, arrows, landmine, Shock waves respectively and other factors including burns, frostbite, being under rubbles, electric shock and accident. 308 (38.7%) of the participants did not have any accompanying injuries. However, 487 (61.3) had one or few accompanying injuries (Table 2). Ankle and leg neuro-musculoskeletal disorders in 319 (40.1%) of patients were in right side; 319 had this injury in the left side and 166 (20.9%) had the injury in both side. The most frequent disorder was lower limb shortening with a frequency of 587 (73.8%) and then ankle dorsiflexion movement range with the frequency of 541(68.5%). Of the 30 (3.8%) that had the amputation, the cause of injury was divided into main groups: 14(46.7%) cases because of land mines and 16 cases (53.2%) because of shrapnel (Table 3). 408 (21.3%) and 367(46.2%) had undergone surgery on their left leg and right food respectively. From injury time to study time, 184(23.7%), 408(52.6%), 61 (7.7%), and 142 (18.9%) of cases had undergone surgery once, twice to five times and more than five times, and no operation respectively. Among the study population, 121 (15.2%) had been hospitalized due to injury during a passing year. In examining the relationship between different variables, a highly significant correlation was existed between the number of child and the employment status in the veterans with leg and angle neuro-musculoskeletal disorders (p<0.05). The majority of the participants (54.0%) with more children were also covered under the Employment Act as there was significant relationship between these two variables (p=0.001). Around three quarters (75.6%) of the participants who were in deprived and disadvantaged economic level were not engaged in any activity. Also, there was a significant relationship between the type of ankle and leg musculoskeletal disorders, and the incidence of injury during the passing year (p=0.04). Veterans whose disorders were in right leg or both leg had more accident compared to those with injured left leg. Also, there was a direct and significant relationship between the percentage of veterans and the incidence of accident during the passing year to the study (p<0.001). There was a significant correlation between the type of injury and numbers of days missed from work during a year to the study (p=0.01) as the veterans with psychiatric injury (22.6%) had more absence from the work. There was completely significant correlation between hospitalization during a year to the study and accompanying injuries (p<0.001) and type of that (p=0.001) as the frequency of hospitalization in the veterans with psychiatric or chemical injuries was significantly higher than other groups. Comparison of different age group and among the groups of veterans with different percentage of injury showed that with increasing age, the number of operation on the injured leg had been significantly increased (p<0.001). There was, also, a direct relationship between percentage of injury and number of operation (p=0.01). Comparison among the groups of veterans with different percentage of injury showed that with the increase in the percentage of injury, the rate of satisfaction with the facilities at work is higher (p=0.008).

… [13-15]. A study of the Canadian soldiers has shown that one of the most reported common problem is ankle sprain that its symptoms are being remained for about a year [16]. Almost all of these people are experiencing limitation of ankle dorsiflexion [17]… [18-60].

Providing job opportunities with suitable conditions and special facilities for the veterans, even in part-time form increases the quality of life in this group.

Given that the demographic form has been completed according to the statements of the veterans and in many cases, they have imposed their personal opinion, the validity of findings are relative.

The limitation of ankle and leg dorsiflexion range of motion and lower limb shortening are the most common injuries reported in veterans with neuro-musculoskeletal disorders. Also, the presence of accompanying injuries is the most important risk factor in the incidence of accidents and physical damages for this group of veterans.

The authors thank and appreciate the Foundation of Martyrs and Veterans Affairs and Veterans Medical Science and Research Center.

Non-declared

This project has been confirmed in the ethical committee of Engineering and Medical Sciences Center.

This study has been conducted with the financial support from Veterans Engineering and Medical Sciences Research Center.

TABLES and CHARTS

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