To compare patient-reported outcomes of disability, activity difficulty, and health-related quality of life (HRQOL) by prosthetic device use and configuration and to identify factors associated with these outcomes.
Population-based sample of veterans (N=755) with unilateral upper limb amputation recruited from a national sample of veterans with upper limb amputation who received care at the Veterans Affairs clinic from 2010-2015.
Main Outcome Measures
Upper limb–related disability was measured using Disabilities of the Arm, Shoulder, and Hand score (QuickDASH). HRQOL was measured using the Veterans RAND 12-item Health Survey Mental and Physical Component scores. Activity difficulty was assessed for 1-handed and 2-handed tasks and by questions about the need for help with activities of daily living (ADLs).
Patients who did not use a prosthesis had more difficulty performing 1-handed tasks using the residual limb as compared with those who used body-powered prostheses. Cosmetic device users had more task difficulty than body-powered or myoelectric users. Linear regression models did not show an association between type of prosthesis used and HRQOL scores, but did show that those who did not use a prosthesis (non-users) had worse QuickDASH scores (β=9.4; P=.0004) compared to body-powered users. In logistic regression modeling, the odds of needing help with ADLs were 1.84 times higher (95% confidence interval, 1.16-2.92) for non-users compared with body-powered users.
Amputees who did not use a prosthesis or used a cosmetic prosthesis reported more difficulty in activities and greater disability as compared with those who use body-powered and myoelectric devices. Non-users were more likely to need help with ADLs as compared with those who used a body-powered prosthesis. Our findings highlight the clinical importance of encouraging prosthesis use. Further research is needed to compare physical performance by prosthesis configuration.
List of abbreviations:ADL (activity of daily living), DOF (degrees of freedom), HRQOL (health-related quality of life), MCS (Mental Component Summary), PCS (Physical Component Summary), QuickDASH (Disabilities of the Arm), Shoulder (and Hand score), VA (Veterans Affairs), VR-12 (Veterans RAND 12-item Health Survey)
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Published online: May 10, 2020
The U.S. Army Medical Research Acquisition Activity, is the awarding and administering acquisition office and this work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Orthotics and Prosthetics Outcomes Research Program Prosthetics Outcomes Research Award (award no. W81XWH-16-2-0065).
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine