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J R R D Volume 47, Number 4, 2010 Pages 349–360 J o u r n a l o f R e h a b i l i t a t i o n R e s e a r c h & D e v e l o p m e n t

Wheeled mobility: Factors influencing mobility and assistive technology in veterans and servicemembers with major traumatic limb loss from Vietnam war and OIF/OEF conflicts

Justin Z. Laferrier, MSPT, OCS, SCS, CSCS, ATP;

1–3

Lynne V. McFarland, PhD;

4–7

Michael L. Boninger,

MD;

1–2,8–9

Rory A. Cooper, PhD;

1–3,8–9*

Gayle E. Reiber, PhD, MPH

4–5

1 Human Engineering Research Laboratories, Department of Veterans Affairs (VA) Rehabilitation Research and Devel- o p m e n t S e r v i c e , P i t t s b u r g h , P A ; 2 V A P i t t s b u r g h H e a l t h c a r e S y s t e m , P i t t s b u r g h , P A ; 3 D e p a r t m e n t o f R e h a b i l i t a t i o n S c i e n c e a n d T e c h n o l o g y , U n i v e r s i t y o f P i t t s b u r g h , P i t t s b u r g h , P A ; 4 D e p a r t m e n t o f H e a l t h S e r v i c e s R e s e a r c h a n d D e v e l - o p m e n t , V A P u g e t S o u n d H e a l t h C a r e S y s t e m , S e a t t l e , W A ; D e p a r t m e n t s o f 5 H e a l t h S e r v i c e s , 6 E p i d e m i o l o g y , a n d 7 M e d i c i n a l C h e m i s t r y , U n i v e r s i t y o f W a s h i n g t o n , S e a t t l e , W A ; 8 D e p a r t m e n t o f P h y s i c a l M e d i c i n e a n d R e h a b i l i t a t i o n a n d 9 D e p a r t m e n t o f B i o e n g i n e e r i n g , U n i v e r s i t y o f P i t t s b u r g h , P i t t s b u r g h , P A

Abstract—Returning wounded veterans and servicemembers to their highest level of function following traumatic injury is a priority of the Departments of Defense and Veterans Affairs. We surveyed 245 veterans from the Vietnam war and 226 ser- vicemembers and veterans from Operation Iraqi Freedom/ Operation Enduring Freedom (OIF/OEF) conflicts with at least one major traumatic lower-limb loss to determine their use of mobility assistive technology (AT) and patterns of limb aban- donment. Prosthetic device use without wheelchair use is found in 50.5% of Vietnam and 42.8% of OIF/OEF groups. Prostheses and supplementary wheelchairs are used by Viet- nam (32%) and OIF/OEF (53%) groups (p < 0.01). Exclusive wheelchair use is more frequent in the Vietnam group (18%) than in the OIF/OEF group (4.0%, p < 0.01). In Vietnam partici- pants, multivariate analysis found that multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.5–38.5), bilateral lower-limb loss (AOR = 12.7; 95% CI

    • 6.2

      –26.1), and number of comorbidities (AOR = 1.3; 95% CI

    • 1.2

      –1.5) are associated with increased likelihood of wheelchair

use. In OIF/OEF participants, bilateral lower-limb loss (AOR = 29.8; 95% CI 11.0–80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1–85.3), cumulative trauma disorder (AOR = 2.4; 95% CI 1.2–4.9), and number of combat injuries (AOR = 1.4;

95% CI 1.2–1.7) are associated with wheelchair use. Combined use of different types of mobility ATs promotes improved reha- bilitation and ability to function.

Key words: combat operations, mobility, mobility assistive technology, OIF/OEF, prosthetic device, rehabilitation, trau- matic amputation, Vietnam, wheelchair, wounded servicemember.

Abbreviations: AOR = adjusted odds ratio, AT = assistive technology, CI = confidence interval, DOD = Department of Defense, OEF = Operation Enduring Freedom, OIF = Opera- tion Iraqi Freedom, PTSD = posttraumatic stress disorder, TBI = traumatic brain injury, VA = Department of Veterans Affairs.

*Address all correspondence to Rory A. Cooper, PhD; VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, 7108 Highland Dr, Bldg 4, Pitts- burgh, PA 15206-1206; 412-365-4850; fax: 412-954-5340. Email: rcooper@pitt.edu

DOI:10.1682/JRRD.2009.03.0022

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