A national study of Veterans with major upper limb amputation: Survey methods, participants, and summary findings

Abstract

IntroductionA 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.MethodsAfter 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%).ResultsRespondents 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.Discussion/ConclusionVeterans 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.

Risk Factors for Neuropathic Pain Following Major Upper Extremity Amputation

“…In this study, 42% of patients developed neuropathic pain after amputation, which is commensurate with, but on the lower range of previous studies (41-73%). [4][5][6] This may be due to the fact that the degree of phantom limb pain generally seems to improve over time, and phantom limb pain in this study was only considered >6 months postoperatively. 28 Additionally, previous studies determined prevalence of phantom limb using follow-up questionnaires with response rates of 34 to 80%, with likely response bias.…”

“…3 Additionally, phantom limb pain occurs in 41 to 73% of major upper limb amputees and appears to correlate with neuroma pain. [4][5][6] As a result of neuropathic pain, prosthesis use is commonly reduced, thus adversely impacting optimal rehabilitation. 5,7,8 Active treatment of nerve ends following amputation or neuroma excision has recently been advocated for the prevention and treatment of neuropathic pain.…”

Housing Needs of Ageing Veterans Who Have Experienced Limb Loss

“…Following amputation, limb-fitting services, along with rehabilitation, are of significant importance in order to improve the prospect of maintaining independence. Resnik [25] suggests that the provision of suitable upper limb prostheses and rehabilitation services can improve satisfaction with a prosthetic limb itself and generally improve quality of life. However, some military veterans who have experienced upper limb amputation choose to abandon or refuse to use their prostheses because they are ill fitting and uncomfortable.…”

Patient Perspectives on Osseointegration: A National Survey of Veterans with Upper Limb Amputation

“…This article reports on the data related to osseointegration. The results of benefit‐risk questions about surgery to restore a sense of touch and provide more control over device movement will be reported elsewhere …”

“…A total of 808 persons completed all or part of the larger national interview survey. This survey, described elsewhere, contained questions related to demographics, amputation level, laterality and etiology, and prosthesis use, as well as standardized measures including the VR‐12 measure of health‐related quality of life (HRQoL). The VR‐12 is a veteran version of the SF‐12 Health Survey that produces the Physical Component Summary (PCS) (Cronbach alpha in this sample = 0.86) and the Mental Component Summary (MCS) (Cronbach alpha in this sample = 0.88) scores …”