A national study of Veterans with major upper limb amputation: Survey methods, participants, and summary findings

IntroductionA comprehensive study to assess quality and outcomes of care for Veterans with upper limb amputation is needed. This paper presents methods and summary findings from a national survey of Veterans with upper limb amputation.MethodsAfter completion of a pilot study to develop and refine methods, computer-assisted telephone interviews were conducted with 808 Veterans with upper limb amputation (response rate = 47.7%; cooperation rate = 63.3%).ResultsRespondents were 776 unilateral and 32 bilateral amputees, 97.5% male, mean age 63.3 (sd 14.1). Prostheses were used by 60% unilateral and 91% bilateral, the majority used body powered devices. Prostheses were used ≥8 hours/day by 52% unilateral and 76% bilateral. Prosthetic training was received by 71% unilateral and 59% bilateral. Mean prosthetic satisfaction was 3.9 (sd 0.6) and 3.8 (sd 0.7) as measured by TAPES; and 25.0 (sd 5.1) and 25.7 (sd 4.5) as measured by OPUS CSD for unilateral and bilateral respectively. Mean perceived disability (measured by QuickDASH) scores were 49.5 (sd 20.7) for unilateral and 34.7 (sd 22.0) for bilateral. VR-12 PCS scores were below population norms. The majority reported contralateral limb pain, musculoskeletal conditions, back and neck pain. Phantom limb pain was reported in 83.4% of unilateral and 68.8% of bilateral, and residual limb pain in 65.1% of unilateral and 68.8% of bilateral. Most, (81.8% unilateral, 84.4% bilateral) had been to a Veterans Affairs medical center (VA) for amputation care, while 57% of unilateral and 81.3% of bilateral had been to a VA amputation clinic.Discussion/ConclusionVeterans with upper limb amputation have moderately impaired physical functioning. Prosthesis use rates were lower than previously reported. Although satisfied with their prostheses, nearly half used them ≤8 hours/day. Rates of musculoskeletal problems, phantom and residual limb pain were higher than previously reported. A substantial proportion never received prosthetic training, or VA amputation care.引言：目前亟需开展一项全面研究，以评估上肢截肢退伍军人的照护质量与照护结局。本文呈现了一项针对上肢截肢退伍军人的全国性调查的研究方法与核心结果。 方法：在完成用于开发并优化研究方法的预试验后，本研究对808名上肢截肢退伍军人开展了计算机辅助电话访谈（应答率=47.7%；合作率=63.3%）。 结果：本次调查的受访者中，776名为单侧截肢者、32名为双侧截肢者，其中97.5%为男性，平均年龄为63.3岁（SD=14.1）。单侧截肢者中60%、双侧截肢者中91%使用了假肢，其中多数采用体动式假肢。单侧截肢者中52%、双侧截肢者中76%每日使用假肢时长≥8小时。单侧截肢者中71%、双侧截肢者中59%接受过假肢适配训练。以TAPES量表评估，单侧、双侧截肢者的平均假肢满意度分别为3.9（SD=0.6）与3.8（SD=0.7）；以OPUS CSD量表评估则分别为25.0（SD=5.1）与25.7（SD=4.5）。以QuickDASH量表评估的感知残疾平均得分，单侧截肢者为49.5（SD=20.7），双侧截肢者为34.7（SD=22.0）。VR-12 PCS得分低于人群常模。多数受访者报告存在对侧肢体疼痛、肌肉骨骼疾病以及腰背与颈部疼痛。83.4%的单侧截肢者与68.8%的双侧截肢者报告存在幻肢痛，65.1%的单侧截肢者与68.8%的双侧截肢者报告存在残肢痛。多数单侧截肢者（81.8%）与双侧截肢者（84.4%）曾因截肢照护前往美国退伍军人事务部（Veterans Affairs，VA）医疗中心就诊；而57%的单侧截肢者与81.3%的双侧截肢者曾前往VA截肢专科门诊就医。 讨论与结论：上肢截肢退伍军人存在中度躯体功能受损。假肢使用率低于既往研究报道水平。尽管受访者对假肢较为满意，但近半数使用者每日佩戴时长≤8小时。肌肉骨骼疾病、幻肢痛与残肢痛的发生率高于既往研究报道。仍有相当比例的受访者从未接受过假肢适配训练，或未接受过VA的截肢专项照护。