Utilization of prostheses and mobility-related assistive technology among service members and veterans from vietnam and operation iraqi freedom/operation enduring freedom

ABSTRACT: A dramatic increase has occurred in the number of service members who have sustained traumatic lower limb amputations over the last decade. As a result, research is needed to establish clinical guidelines by which to provide the most appropriate prosthetic technology during rehabilitation. This technology is needed to meet the primary focus of the US Department of Defense and the US Department of Veterans Affairs to return service members to their highest level of function after lower limb amputation. Because of physical impairment and decreased functional capacity resulting from the loss of one or more limbs, as well as possible concomitant injuries sustained during a traumatic event, these veterans use a wide variety of mobility-related assistive technology (MAT). Assistive devices such as prostheses, wheelchairs, walkers, crutches, and canes are commonly used by this population either as a primary device (when an individual uses a prosthesis without any other assistive device such as a cane or crutches) or a secondary device (when an individual needs the assistance of one or more devices in combination with his/her primary device) as a means of mobility. Mobility-related assistive technology is designed to increase the user's functional capacity, mobility, accessibility to the world at large, and overall quality of life. However, in the civilian population, MAT is frequently underused and/or discontinued, with abandonment rates as high as 30% being reported. In this study, we investigated the potential shift in use of various types of MAT over time among community-dwelling individuals and identified the reasons for these shifts and/or abandonment by veterans with at least one major limb amputation. We found that the average military service member inpatient rehabilitation length of stay (LOS) was 5.77 ± 6.79 months, a statistically significant difference in stay compared with civilian medicine (LOS, 22-35 days). Furthermore, this information, along with the identification of underlying factors associated with the transition from lower limb amputation, will provide essential information to help guide prescription of MAT and develop focused rehabilitation programs.