Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study

Abstract

Purpose: To present population data on standardized measures of dexterity, activity performance, disability, health-related quality of life (HRQoL) and community integration for persons with upper limb amputation (ULA), compare outcomes to normative values, and examine differences by prosthesis type and laterality (unilateral vs. bilateral amputation). Materials and methods: Multi-site, cross-sectional design, with in-person evaluations, functional performance, and self-report measures. Descriptive and comparative analyses were performed by amputation level and prosthesis type, data were compared for unilateral and bilateral amputation. Results: One hundred and twenty-seven individuals participated; mean age 57 years, 59% percent bodypowered prostheses users. All measures of dexterity differed (p < 0.05) by amputation level and by laterality. All measures of activity differed by amputation level with the best scores in transradial (TR) amputation groups. Comparisons of body-powered users with TR amputation found that dexterity was better for those with bilateral compared to unilateral amputation. Conclusions: Dexterity is markedly impaired in persons with ULA. Individuals with more proximal ULA levels are most impacted. HRQoL and community participation are less impacted and more equivalent to unimpaired persons. Further research is needed to examine differences by terminal device type and determine how best to match persons with ULA to the optimal prosthesis type and componentry, based on individual characteristics. ä IMPLICATIONS FOR REHABILITATION This study provides population-based, comparative data on dexterity, activity performance, disability, quality of life, and independence in upper limb prosthesis users. The study provides preliminary analyses comparing the effectiveness of body-powered devices, myoelectric devices with single degree of freedom and multi-degree of freedom terminal devices. The data presented in this study can be used to benchmark outcomes in patients who are upper limb prosthesis users. The data will also be useful to inform comparative evaluations of existing and emerging prosthetic technology.

Assessment of Patient-Reported Physical Function in Persons With Upper Extremity Amputation

“…Finally, to examine whether the PROMIS UE versions differed for subgroups as expected based on clinical observation and previous research, 25 we compared scores of the six various configurations of the PROMIS measure for prosthesis users and nonusers and for persons of varying amputation level. Because of potential confounding of amputation level and prosthesis use (persons with more proximal amputation are less likely to be prosthesis users), we also stratified the data by prosthesis use and compared scores within amputation level.…”

Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users

“…The DIF analyses suggested that bilateral amputees found tasks requiring fine force regulation with the prosthesis easier than unilateral amputees, but certain dexterous bilateral activities, such as tying a knot, more difficult than unilateral amputees. Neither of these results are surprising, given that bilateral amputees cannot rely on their intact limb for fine force regulation and thus develop more dexterity on their dominant prosthetic side [27]. Further, bilateral amputees cannot use an intact limb during bilateral activities, making these activities more difficult.…”

Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans With Upper Limb Amputation

“…Participants in this analytic subsample were a subset of the sample recruited for a more comprehensive parent study described elsewhere. 2 These subjects were a convenience sample of service members, veterans, and civilians who had unilateral major ULA or limb deficiency at the above-elbow (AE) or below-elbow (BE) level. The AE levels included elbow disarticulation (ED) and transhumeral (TH) levels.…”