Date Published: March 14, 2019
Publisher: Public Library of Science
Author(s): Linda Resnik, Sarah Ekerholm, Matthew Borgia, Melissa A. Clark, Arezoo Eshraghi.
A comprehensive study to assess quality and outcomes of care for Veterans with upper limb amputation is needed. This paper presents methods and summary findings from a national survey of Veterans with upper limb amputation.
After completion of a pilot study to develop and refine methods, computer-assisted telephone interviews were conducted with 808 Veterans with upper limb amputation (response rate = 47.7%; cooperation rate = 63.3%).
Respondents were 776 unilateral and 32 bilateral amputees, 97.5% male, mean age 63.3 (sd 14.1). Prostheses were used by 60% unilateral and 91% bilateral, the majority used body powered devices. Prostheses were used ≥8 hours/day by 52% unilateral and 76% bilateral. Prosthetic training was received by 71% unilateral and 59% bilateral. Mean prosthetic satisfaction was 3.9 (sd 0.6) and 3.8 (sd 0.7) as measured by TAPES; and 25.0 (sd 5.1) and 25.7 (sd 4.5) as measured by OPUS CSD for unilateral and bilateral respectively. Mean perceived disability (measured by QuickDASH) scores were 49.5 (sd 20.7) for unilateral and 34.7 (sd 22.0) for bilateral. VR-12 PCS scores were below population norms. The majority reported contralateral limb pain, musculoskeletal conditions, back and neck pain. Phantom limb pain was reported in 83.4% of unilateral and 68.8% of bilateral, and residual limb pain in 65.1% of unilateral and 68.8% of bilateral. Most, (81.8% unilateral, 84.4% bilateral) had been to a Veterans Affairs medical center (VA) for amputation care, while 57% of unilateral and 81.3% of bilateral had been to a VA amputation clinic.
Veterans with upper limb amputation have moderately impaired physical functioning. Prosthesis use rates were lower than previously reported. Although satisfied with their prostheses, nearly half used them ≤8 hours/day. Rates of musculoskeletal problems, phantom and residual limb pain were higher than previously reported. A substantial proportion never received prosthetic training, or VA amputation care.
Appropriate provision of upper limb prostheses and rehabilitation services can improve satisfaction with the prosthetic limb, reduce device abandonment and improve overall quality of life. Regular use of a prosthesis may also prevent cumulative trauma disorders (CTD) in the sound side limb, as well as back and neck pain related to poor compensatory strategies, common problems of upper limb amputees.[2, 3] Limited research shows that prosthesis use is associated with improved performance in hygiene, grooming and dressing. In contrast, non-use of a prosthesis is associated with development of one-handedness, and limitations in strength, flexibility, endurance, and mobility.[5, 6]
The study consisted of development and refinement of survey content and then administration of the survey to a national sample of Veterans at baseline and at 12-month follow-up. This manuscript reports on the cognitive interviews and pretesting for survey refinement as well as baseline data collection efforts. Future reports will address the 12-month follow-up data.
We conducted the first-of-its-kind national study of Veterans with major upper limb loss. Our study was by far the largest study of Veterans with upper limb amputation conducted to date, and its sampling strategy and analytical methods make the results generalizable to Veterans with upper limb amputation who were seen at the VA for care. We characterized amputation level and etiology, prosthesis and terminal device types used, prosthesis suspension methods, as well amount and frequency of prosthesis use and prosthesis training receipt. For persons who had abandoned using a prosthesis, we also described the reasons for abandonment by device type. Additionally, we compared prosthetic satisfaction, and several measures of health-related quality of life of unilateral and bilateral amputees.
This paper reports summary findings from the first ever nationally representative study of Veterans with all cause upper limb amputation, and one of the largest studies to describe upper limb amputees, their prosthesis use, satisfaction with devices, health-related quality of life and care receipt. We found that rates of prosthesis use were lower than reported in samples of combat Veterans. Body powered devices were used by 70.9% of unilateral and 76.0% (on left) and 77.8% (on right) of bilateral amputees. Multi-degree of freedom terminal devices, used by 11% of unilateral amputees, were not used by any bilateral amputees. Overall, we found that Veterans who were prosthesis users were somewhat satisfied with their devices, although only 52% utilized their devices at least 8 hours per day and substantial proportion used them less than 2 hours per day. A substantial proportion of respondents had not received any training to use either their initial prostheses, or their current prostheses.