2019 PRORP Vignette

Title: Focusing on Optimal Recovery and Restoration for our Servicemembers

CAPT Eric Hofmeister, MD (USN, Ret.); Synergy Specialist Medical Group

The PRORP panel is made up of people who are from very diverse backgrounds. They include surgeons, scientists, therapists, different types of clinicians, all involved in orthopaedic care. In addition, we actually have a couple consumers on the panel who have lost limbs during military operations, and they serve also as very integral partners on the panel, giving not only experiences that they’ve had, but also experiences to the number of people that they personally know that have been injured. We meet once or twice a year to review research proposals and discuss what the current gaps are in the treatment of war-related injuries and try to come up with the best research studies that are available.

I was the Specialty Leader for all of orthopaedics to the Surgeon General, and it was at that time that someone invited me to be on the panel, based on my clinical experience along with some research experience I had, to help serve as one of the panel members.

The PRORP really tries to focus on research that’s going to benefit those directly involved and who have been injured in combat situations, and unique combat situations that maybe we don’t see in everyday medical practices—things such as horrific multi-limb injuries, penetrating pelvic injuries, a huge amount of loss of muscle or function to a limb. So the program is really trying to focus on research to bridge those gaps that we have no answers to right now. So there are several big areas that we try to focus on, and they include amputee care, development of new types of prosthetics and prosthetic limb interfaces, segmental nerve injuries, large devastating amounts of muscle loss, and also for large segmental bone loss or injuries that have lost a large portion of tissue.

So the program really tries to focus on everything from the initial care of these injuries to definitive treatment and prevention of long-term injuries with these. We try to stay focused predominantly in the surgical and the immediate care afterwards, but certainly we have focus areas where we’re trying to mitigate sequelae from these injuries 10 and 15 years from now.

This year we have just three different types of study award mechanisms. They include the very expensive Clinical Trial Studies, Clinical Translational Studies, and Applied Research Studies.

The Clinical Trial Studies is generally a human trial that, once completed, are likely to change our clinical guidelines. So, in other words, if successful, the thought is that we would be able to implement whatever the study was looking at. They often are multi-centered studies and, of course, are very expensive to run and often are answering a very specific question.

The Clinical Translational Awards are studies that are getting close at being run as a prospective multi-center study, but maybe are not there quite yet. Maybe they’re having to perfect a certain implant. Maybe they’re going from a bench research to an animal model. They’re something that they’re not quite ready to be trialed in humans yet.

The Applied Research Award is a bench research award. It’s based on studies that have already been done that they’re then trying to advance what has already been proven; or they’re trying to find something that they can then build on at a later time.

So my advice for people who are applying for these research awards is to know, one, they are very competitive. They’re high-value dollars that we’re giving out, and they really should be mentoring or have well-seasoned researcher people that are helping them with this project. We’re looking for multi-institutional studies potentially. We’re looking for interactions between civilian and orthopaedic researchers. And be sure you read the requirements for each of the mechanisms. We changed the different funding mechanisms throughout the years, and you want to make sure that their study fits exactly into a need and into the correct research funding mechanism. We’re really looking to fund research that will make an impact on the injured Service men and Service women of our country. So there really has to be a clinical relevance to that subgroup of patients.

I think one of the greatest things is when I’m at a scientific meeting or I’m reading an article and I look down at the small print at the bottom of the slide and see that the funding was in part or in full from the PRORP. That’s when you know that you’re really making a difference when you see this research presented. And probably the ultimate is when you then implement things on patients that you know was previously funded through this organization.

We are very fortunate to be in this country. I’ve spent 27 years in the Navy, and the citizens of this country recognized that if we’re going to take young men and women and put them in harm’s way, that we owe it to them to make sure that they get the best ultimate care possible. And one way of doing that is trying to continue to do research in some of these devastating injuries to ensure that those people get that care in the future.