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JRRD Single-Topic Issue Reports on Results of First National Survey of Veterans with Traumatic Limb Loss


FINDINGS INCLUDE:

  • Despite traumatic limb loss, health status was rated excellent, very good, or good by 71% of Vietnam Veterans and 86% of OEF/OIF service members/Veterans who participated in this study. However, many health issues persist: phantom pain (72%, 76%, respectively), chronic back pain (36%, 42%), residual limb pain (48%, 63%), prosthesis-related skin problems (51%, 58%), hearing loss (47%, 47%), traumatic brain injury (3%, 34%), depression (24%, 24%), and PTSD (38%, 59%).
  • Among Veterans who have lost a limb, prosthetic devices are currently used by 78% of Vietnam Veterans and 90.5% of OEF/OIF service members/Veterans to improve function and mobility. On average, the annual rate for receiving a limb prosthesis is nearly 11-fold higher for OEF/OIF than for Vietnam participants.

EXPERT PANEL RECOMMENDATIONS INCLUDE:

  • Person-centered approach to Veterans with limb loss that recognizes the need to partner with Veterans for life-long support; this should be the core of the VA Paradigm Shift in limb loss care.
  • Uniform standard of care for all Veterans with limb loss regarding training and provision of prosthetic devices.
  • Creation of a VA Limb Loss Registry using the VA Corporate Data Warehouse. This registry can facilitate care coordination, communication, and research by VA and DoD investigators.
  • Clinical template to document limb loss-related care, services, and visits should be added to the VA electronic medical record.

BACKGROUND:
Prosthetic care is only one important aspect of the complex rehabilitation partnership between the Veteran with limb loss and VA. To assess Veterans' current perspective in this rehabilitation partnership, the Survey for Prosthetic Use was initiated. This issue of JRRD reports the results of the first nationally representative survey of Vietnam Veterans (n=298) and service members and Veterans from OEF/OIF (n=283) who sustained major traumatic limb loss while serving. Participants in the Survey identified their level(s) of limb loss, concurrent injuries and illness, health status, quality of life, and physical function. They also documented their use, replacement, rejection, and abandonment of prosthetic devices, as well as their satisfaction with prosthetic and assistive devices. Members of a Prosthetics Expert Panel, which included 27 professionals from academic and clinical settings, clinicians and researchers from VA and DoD, and three Veterans with limb loss, analyzed Survey findings. Panel members then wrote articles based on the Survey data, presenting survey findings as well as Expert Panel recommendations.

IMPLICATIONS:

  • A new VA Amputation System of Care will be fully implemented by the end of 2010.


Journal of Rehabilitation Research & Development (JRRD) June 2010;47(4)

AUTHOR/FUNDING INFORMATION:
The "Survey for Prosthetic Use" was supported by HSR&D (IIR 05-244). Health Services Research and Development Service July 2010


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APPENDIX

JRRD June 2010;47(4)

Reiber G and Smith D. Guest Editorial: VA Paradigm Shift in Care of Veterans with Limb Loss. p. vii

Pasquina P. Guest Editorial: DoD Paradigm Shift in Care of Service Members with Major Limb Loss. p. xi

Sigford B. Guest Editorial: Paradigm Shift for VA Amputation Care. p. xv

Arredondo J, Foote N, Pruden J, et al. Guest Editorial: The Wounded Warriors' Perspectives: Helping Others to Heal. p. xxi

Reiber G and the Prosthetics Expert Panel. Guest Editorial: Expert Panel Recommendations. p. xxix

Reiber G, McFarland L, Hubbard S, et al. Service Members and Veterans with Major Traumatic Limb Loss from Vietnam War and OIF/OEF Conflicts: Survey Methods, Participants, and Summary Findings. p. 275

McFarland L, Hubbard S, Heinemann A, et al. Unilateral Upper Limb Loss: Satisfaction and Prosthetic Device Use in Veterans and Service Members from Vietnam and OIF/OEF Conflicts. p. 299

Gailey R, McFarland L, Cooper R, et al. Unilateral Lower Limb Loss: Prosthetic Device Use and Functional Outcomes in Service Members from Vietnam War and OIF/OEF Conflicts. p. 317

Dougherty P, McFarland L, Smith D, et al. Multiple Traumatic Limb Loss: A Comparison of Vietnam Veterans to OIF/OEF Service Members. p. 333

Laferrier J, McFarland L, Boninger M, et al. Wheeled Mobility: Factors Influencing Mobility and Assistive Technology in Veterans and Service Members with Major Traumatic Limb Loss from Vietnam War and OIF/OEF Conflicts. p. 349

Berke G, Fergason J, Milani J, et al. Comparison of Satisfaction with Current Prosthetic Care in Veterans and Service Members from Vietnam and OIF/OEF Conflicts with Major Traumatic Limb Loss. p. 361

Epstein R, Heinemann A, and McFarland L. Quality of Life for Veterans and Service Members with Major Traumatic Limb Loss from Vietnam and OIF/OEF Conflicts. p. 373

Blough D, Hubbard S, McFarland L, et al. Prosthetic Cost Projections for Service Members with Major Limb Loss from Vietnam and OIF/OEF. p. 387

Maynard C, Flohr B, Guagliardo T, et al. Department of Veterans Affairs Compensation and Medical Care Benefits Accorded to Veterans with Major Limb Loss. p. 403

McFarland L, Choppa A, Betz K, et al. Resources for Wounded Warriors with Major Traumatic Limb Loss. p. 415

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.