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Justin Z. Laferrier, MSPT, OCS, SCS, CSCS, ATP; - page 4 / 12





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JRRD, Volume 47, Number 4, 2010

bilateral limb loss (84 limbs), and 12 had multiple- limb loss (31 limbs), for a total of 287 limbs. The multiple- limb-loss participants from the OIF/OEF group includes three subgroups: (1) loss of one upper and one lower limb (total 10 limbs), (2) loss of two upper limbs and one lower limb (total 6 limbs), and (3) loss of one upper and two lower limbs (total 15 limbs).

The Vietnam group was 100 percent male; the OIF/ OEF group was 98 percent male. The mean age of the Vietnam group with lower-limb loss was significantly older than the OIF/OEF group: 60.7 ± 2.9 and 29.0 ± 5.6, respectively, p < 0.001. (Values are expressed as mean ± standard deviation, unless otherwise stated.) Mean age and race are not significantly different in the three lower- limb groups within conflict groups (data not shown). A description of other differences (comorbidities, combat injuries, quality of life, and types of prosthetic devices) is found in other articles in this issue [11,16–18].

Prosthetic Device Use

Current prosthetic device use with or without wheel- chair use is common in all three lower-limb loss groups (Table 1). Of those who ever received any prostheses, current use of prosthetic devices (with or without wheel- chair use) is highest in the unilateral lower-limb loss group for both the Vietnam (84%) and OIF/OEF (96%) participants. Fewer of the Vietnam war participants (67%) with bilateral lower-limb loss currently use pros- theses compared with OIF/OEF participants (95%) (p < 0.001). Current use of prostheses is similar for Vietnam and OIF/OEF groups with other lower multiple-limb loss (92% and 90%, respectively). Exclusive use of prosthetic devices (without wheelchair use) is similar for the Vietnam and OIF/OEF groups (50.5% and 42.8%, respectively).

Wheelchair Use

Sole or supplementary wheelchair use is common in both conflict groups: 50 percent of the Vietnam and 57 percent of the OIF/OEF participants use wheelchairs. Wheelchair use is highest in those with bilateral lower- limb loss in Vietnam (80%) and OIF/OEF (90%, p = 0.05) groups. Wheelchair use is also high in those with multiple-limb loss for both the Vietnam (71%) and OIF/ OEF (77%) groups. For those with unilateral lower-limb loss, wheelchairs are used less frequently in the Vietnam (28%) than the OIF/OEF (37%, p = 0.04) group.

We also examined how prosthetic devices and wheel- chairs are used in combination (Table 1). Supplementary

wheelchair use with prostheses occurs in 32 percent of the Vietnam and 53 percent of the OIF/OEF participants (p < 0.001). In contrast, fewer used wheelchairs exclu- sively: 18 percent of Vietnam and 4 percent of OIF/OEF participants (p < 0.001). In both conflict groups, the prin- ciple mobility AT depends on the type of limb loss. For unilateral lower-limb loss, prostheses without wheelchair use are the principle mobility ATs for 72 percent of the Vietnam and 63 percent of the OIF/OEF group (data not shown). In contrast, the most frequent mobility AT use for bilateral lower and multiple-limb loss groups is a combination of prosthetic devices and supplementary wheelchair use. Supplementary chair use is significantly higher in bilateral lower-limb participants in the OIF/ OEF group (83%, p = 0.006) compared with the Vietnam group (46%) (Table 1). A trend exists for supplementary wheelchair use to be higher in the OIF/OEF group (77%) with multiple-limb loss compared with the Vietnam group (56%, p = 0.09).

Infrequently, wounded veterans and servicemembers do not receive any prostheses, transitioning instead directly into wheelchairs after rehabilitation for their mobility (Table 1). This transition is infrequent in both the Vietnam (5.0%) and OIF/OEF (1.8%) groups, and most (75%) were at the transfemoral level (data not shown).

Abandonment of Prostheses

While most survey participants continue using pros- theses, some completely discontinue all lower-limb pros- theses because of a variety of reasons (pain, dissatisfaction, comorbidities, etc.) [17]. Abandonment of all prosthetic devices is significantly more frequent in the Vietnam par- ticipants (17%) compared with OIF/OEF participants (5%, p < 0.001). Abandonment is highest (Table 1) in the Vietnam bilateral lower-limb loss group (33%) and is significantly lower in the OIF/OEF group with bilateral limb loss (5%, p = 0.001). Both conflict groups with mul- tiple-limb loss report low abandonment frequency (7%– 10%) of prostheses. In the Vietnam group, the types of abandoned prostheses were mostly mechanical devices (mean number abandoned: 1.6 ± 1.5 unilateral lower- limb loss, 2.0 ± 1.3 bilateral lower-limb loss, and 1.2 ± 1.3 multiple-limb loss). Few of the abandoned prostheses in the Vietnam group were advanced (microprocessor) types: mean of 1 ± 0 for bilateral lower limb and mean of

  • 0

    for unilateral lower or multiple-limb loss. In the OIF/

OEF group, more of the abandoned prostheses were also mechanical (mean 3.5 ± 4.3 for unilateral lower, 1 ± 0 for

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