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Justin Z. Laferrier, MSPT, OCS, SCS, CSCS, ATP; - page 2 / 12

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JRRD, Volume 47, Number 4, 2010

INTRODUCTION

Traumatic injuries such as amputations, spinal cord injuries, burns, and multiple orthopedic and neurological disorders occur in combat operations [1–2]. Many of these injuries result from high concussive force blasts due to improvised explosive devices. Advances in early combat medical care and improvements in vehicle and personal armor are increasing survival rates, leading to increasing numbers of veterans and servicemembers liv- ing with a variety of severely disabling conditions [1–4].

The Department of Defense (DOD) instituted a recent rehabilitation directive aiming to return service- members with major traumatic amputations from Opera- tion Iraqi Freedom (OIF) in Iraq and Operation Enduring Freedom (OEF) in Afghanistan to their highest possible functional level so that major limb loss does not prevent them from maximizing their career options in the military or civilian sectors [4–6]. To this aim, the Armed Forces Amputee Patient Care Programs at Walter Reed Army Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego deliver high-intensity, multidisciplinary rehabilitation combined with the latest assistive technology (AT) designed to return service- members with lower-limb amputations to their highest possible level of function [7].

Because of the physical impairment and decreased functional capacity, resulting from limb loss, as well as possible concomitant injuries, wounded servicemembers and veterans may use a wide variety of mobility AT. Mobility ATs include all technologies used to facilitate independent mobility (prosthetic devices, wheelchairs, or assistive devices). Mobility ATs are designed to increase the users’ functional capacity and mobility and their access to the world. However, mobility ATs are frequently underused or discontinued, with abandonment rates as high as 30 percent [8]. The economic loss related to mobility AT abandonment and the possible long-term negative effects of inappropriate initial prescription moti- vated researchers to investigate underlying factors for underuse and abandonment to lower abandonment rates and improve prescription practices, thereby improving function in veterans and servicemembers with limb loss. In addition, currently, 18 to 21 percent of the service- members with traumatic amputations from the conflicts in Iraq and Afghanistan are returning to full Active Duty [6], compared with prior conflicts during which approxi- mately 2 to 7 percent returned to Active Duty [9–10].

How different mobility ATs can help servicemembers return to Active Duty is unknown. Currently, little evi- dence-based literature exists related to the prescription of AT in those with combat-associated lower-limb loss.

This article investigates the factors for mobility AT use and abandonment in Vietnam and OIF/OEF groups with major lower-limb loss. These two distinct groups were chosen because they represent patterns of prosthetic device use before and after DOD rehabilitation programs were significantly changed for servicemembers with limb loss [4].

METHODS

Study Design

This study is a cross-sectional descriptive survey of all OIF/OEF veterans and servicemembers with major limb loss (as of 2008) and a sample of Vietnam war vet- erans with major limb loss.

Study Participants

Participants in this study were veterans and service- members from the Vietnam war and OIF/OEF conflicts, with at least one major traumatic amputation (excludes digits only) associated with a combat-field injury. These two groups were chosen to reflect mobility AT use before and after major changes were instituted in DOD rehabili- tation care for battlefield injuries involving limb loss. We surveyed veterans and servicemembers during 2007 and 2008 to determine their general medical history and cur- rent health issues; prosthetic use, replacement, and aban- donment patterns; satisfaction with prostheses; and use of other assistive devices. A description of the detailed study methods is found in this issue [11] and in the national Survey for Prosthetic Use, Appendix 1 (available online only).

Mobility Assistive Technologies

Mobility AT includes the use of prosthetic devices, wheelchairs (electronic, manual, or electronic scooters), and assistive devices. Wheelchair use was grouped into sole use (no prostheses) or supplementary wheelchair use (with prostheses). Assistive devices include canes, crutches, walking canes with attached seats, and rolling walkers with knee support. Questions on mobility AT were asked as part of the Survey for Prosthetic Use (Appendix 1 available online only) [11]. This survey

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