Understanding long-term physical and psychosocial outcomes from conflict to rehabilitation through the ADVANCE cohort

Throughout the history of conflict, medical advancements have improved people's survival. Many individuals sustain physical and mental scars, often unseen and impacting on future health. Improvements in clinical care are often translated into practice, but long-term health impacts may not be appreciated until later. Most post-conflict data related to health outcomes of military personnel are limited by retrospective methodologies examining isolated results or surrogate measures of health. The ADVANCE cohort aims to prospectively understand the long-term physical and psychosocial outcomes of conflict-injured UK Service personnel who served in Afghanistan compared to an uninjured comparison group. This review will outline cardiovascular, mental health and musculoskeletal findings in this cohort, discuss the evolution of the objectives to understand associated mechanisms and mediators, and demonstrate the initial impact and relevance for military and civilian populations worldwide. Finally, two participants reflect on their involvement in the ADVANCE cohort and its impact from their perspective.