Predicting prosthetic prescription after major lower-limb amputation

Area of Science:

• Rehabilitation Medicine
• Amputee Care
• Prosthetics

Background:

• Lower-limb amputation necessitates prosthetic limb prescription for functional recovery.
• Understanding factors influencing prosthetic prescription is crucial for optimizing veteran care.
• Variability in prosthetic prescription suggests underlying regional or patient-specific influences.

Purpose of the Study:

• To describe prosthetic limb prescription patterns in the first year post-lower-limb amputation.
• To examine the association between amputation level, geographic region, and prosthetic prescription among Veterans.
• To identify patient characteristics associated with prosthetic prescription.

Main Methods:

• Analysis of 2005-2010 Department of Veterans Affairs (VA) data, including inpatient, medical encounters, vital status, and prosthetic patient databases.
• Inclusion of 9,994 Veterans who underwent lower-limb amputation at a VA hospital.
• Utilized descriptive statistics, bivariates, and Cox proportional hazard models to identify factors associated with prosthetic prescription.

Main Results:

• Amputation level significantly impacted prosthetic prescription: ankle amputation (HR=1.41) and transfemoral amputation (HR=0.46) compared to transtibial amputation.
• Geographic region showed significant variation: Northeast (HR=1.49), Upper Midwest (HR=1.26), and West (HR=1.39) compared to the South.
• Negative associations with prosthetic prescription included African American race, longer hospital stay, older age, comorbidities (CHF, paralysis, neurological disease, renal failure), and nursing facility admission. Being married was positively associated.

Conclusions:

• Ankle amputations were most likely to receive prostheses, whereas transfemoral amputations were least likely, after adjusting for patient factors.
• Significant geographic variations in prosthetic prescription exist within the VA system.
• Further research is warranted to elucidate the reasons behind these observed geographic disparities in prosthetic prescription.