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Justin Z. Laferrier, MSPT, OCS, SCS, CSCS, ATP; - page 7 / 12

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7 / 12

Weight Gain

0

2 (8.3)

0

2 (5.1)

Total

12*

24*

3

39 (100)

Too Heavy

3 (25.0)

4 (16.7)

0

7 (18.0)

Pain

1 (8.3)

6 (25.0)

0

7 (18.0)

Too Much Fuss

1 (8.3)

4 (16.7)

0

5 (12.8)

Cumulative Trauma Disorder

5 (41.7)

0

0

5 (12.8)

Combat Injury—Other Limb

0

0

0

0

Need Arms

0

0

3 (100)

3 (7.7)

Paralysis

1 (8.3)

0

0

1 (2.6)

Residual Limbs Too Short

1 (8.3)

8 (33.3)

0

9 (23.1)

Too Heavy

0

0

0

0

Too Much Fuss

0

2 (50.0)

0

0

Cumulative Trauma Disorder

1 (25)

0

0

3 (37.5)

Combat Injury—Other Limb

2 (50)

0

0

2 (25.0)

Need Arms

0

2 (50)

0

2 (25.0)

Total

4

4

0

8 (100)

355

OIF/OEF

  • *

    Excludes missing data.

LAFERRIER et al. Mobility and AT in servicemembers with major traumatic limb loss

Vietnam

Table 3. Principle reason by number and percentage (%) for prosthetic device abandonment among wheelchair users in Vietnam and Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) groups with major traumatic lower-limb loss by involved limb.

Unilateral

Bilateral

Lower-Limb Loss

Lower-Limb Loss

Other Multiple-Limb Loss Including 1

Lower Limb

Total

Principle Reason for

Lower-Limb Abandonment

activities (50%). For those with multiple-limb loss, need- ing arms (100% of Vietnam group) was the most com- mon reason for prosthetic device abandonment.

Assistive Devices

Assistive devices, especially canes and crutches, were used less often than prosthetic devices or wheel- chairs by the Vietnam and OIF/OEF groups with lower- limb loss; however, they are still considered important mobility aids (Table 4). Crutches were used in 41.6 per- cent of those with unilateral lower-limb loss in the Viet- nam group and 49.4 percent of the OIF/OEF group. Canes were used most frequently by the OIF/OEF group with bilateral limb loss (54.8%) but were less frequently used by the Vietnam group (27%). In those with multiple- limb loss, canes were most frequently used (35.3%) in the OIF/OEF group and less so (13.6%) in the Vietnam group.

Multivariate Analysis for Wheelchair Use

We analyzed factors associated with either sole or supplementary wheelchair use using logistic regression analysis for each conflict group separately (Table 5). In the Vietnam group, three factors significantly increased

the likelihood of wheelchair use: multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.4, 38.4), bilateral lower-limb loss (AOR = 12.7; 95% CI 6.2, 26.1), and an increasing number of comorbidities (AOR = 1.3; 95% CI 1.1, 1.5). Two factors were significantly associated with less likely use of wheelchairs: ambulatory (AOR = 0.05; 95% CI 0.01, 0.24) and highly active (AOR = 0.02; 95% CI 0.01, 0.12). In the OIF/OEF group, four factors significantly increased the likelihood of wheelchair use: bilateral lower-limb loss (AOR = 29.7; 95% CI 11.0, 80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1, 85.3), cumulative trauma dis- order to the contralateral lower limb (AOR = 2.4; 95% CI 1.2, 4.9), and the number of combat-associated injuries received (AOR = 1.4; 95% CI 1.1, 1.6). No significant interaction terms were found in either model, and other factors analyzed were not significant including age, sex, race, weight gain, pain (residual limb, back), mental health conditions (depression), quality of life, prosthetic device satisfaction and fit, health status, stroke, PTSD, TBI, phantom limb sensation, number of postlimb-loss surgeries, or type of prosthetic device used.

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