Associations Between Behavioral Health Conditions, Traumatic Brain Injury, and Other Clinical Factors with Patient-Reported Outcomes in the MHS Limb Loss Population – A Cross-Sectional Study

Background: Military Health System (MHS) beneficiaries with limb loss often experience comorbidities, including traumatic brain injury (TBI) and behavioral health (BH) conditions which are associated with variations in rehabilitation outcomes.Understanding their relationship with patient-reported outcomes is critical. J o u r n a l P r e -p r o o fObjectives: This study aimed to 1) describe health-related quality of life (HrQoL) in MHS beneficiaries with limb loss and compare it to population norms, and 2) examine the associations of BH conditions, TBI, and other clinical factors with HRQoL.Methods: This retrospective cross-sectional study analyzed data from 312 adult MHS beneficiaries with limb loss who completed the PROMIS-29 v2.0 questionnaire.Sample scores were compared to population norms using t-tests.Multiple linear regression models examined associations between demographic and clinical factors and eight PROMIS-29 outcomes. Results:The sample (N=312) included 24% with BH conditions and 3.5% with TBI.Compared to the general population, the sample reported significantly worse outcomes for physical function, anxiety, sleep disturbance, social participation, and pain interference (p < 0.01).In multiple regression models, BH conditions were associated with worse outcomes across nearly all domains, across nearly all domains, with the strongest associations for anxiety, depression, and fatigue (p < 0.05).TBI was significantly associated with worse sleep disturbance, pain interference, and pain intensity (p < 0.05).Limb loss etiology (traumatic vs. acquired) was not significantly associated with HRQoL. Conclusion:BH conditions and TBI are associated with distinct, negative impacts on HRQoL.These findings support moving beyond general screening toward proactive interventions.Rehabilitation programs should consider implementing targeted strategies for pain and fatigue in patients with known BH conditions and for sleep disturbance in patients with a history of TBI.