This cohort of combat casualties from Iraq and Afghanistan should not have survived; but they did. Their survival should now be defined by their disability; yet it is not. Using a mixed method research approach underpinned by complexity science and social theory, this study critically examines military rehabilitation post lower limb amputation and key components required to manage their complex needs. Structured around an adapted MRC evaluation framework for complex interventions, perspectives of clinicians, clinical managers and veterans have been captured and verified using the Nominal Group Technique, interviews, and veteran outcome data (ADVANCE).
Clinicians and clinical managers cite the importance of a highly collaborative interdisciplinary team approach where a culture of innovation, creativity, trust, and interdependence is nurtured by leaders. Conversely, the multidisciplinary team structure led to feelings of distrust, inadequacy, isolation, and disempowerment to adapt their circumstance.
Veterans highlight the prosthetic limb as a powerful symbol of autonomy and group membership; social bonds with peers, family and trusted clinicians, and the intensive goal centred, functionally based, rehabilitation process are also prized. These components support veterans to acquire the skills needed to feel connected with others and act autonomously – verified in the literature as extrinsic enablers of human thriving. The ADVANCE cohort presented with a high severity of injury, yet remarkably no psychological or social decline when compared to uninjured controls. However, psychosocial outcomes did not depend on prosthetic mobility as previous research has shown.
Therefore, both qualitative and quantitative data, point to a social dynamic supporting clinicians and patients to achieve their intrinsic motivational needs – to feel connected, competent, autonomous, and thereby, to thrive. Rehabilitation programmes planned around the proposed model of human thriving should promote high levels of social, psychological, and physical recovery. Future research is suggested on factors impeding thriving, mental health, socket comfort and medication.