Lower extremity prosthesis usage among U.S. veterans: 10-year cohort study

Investigate the usage of lower extremity prostheses among U.S. veterans, focusing on potentially modifiable factors such as pain, weight, comorbidities, and skin issues, and analyze prosthesis use among subpopulations. Secondly, describe veteran prosthesis provision.

10-year retrospective cohort study (2011-2021) using data from 300 randomly selected U.S. veterans receiving care at a single amputation clinic. Self-reported prosthesis usage was the primary outcome. We conducted bivariate analyses and multivariate regressions to determine associations between prosthesis usage and the proposed variables.

Sex, etiology, smoking, comorbidities, and amputation characteristics had significant associations with usage. Pain and body weight had significant but weak associations with usage. Participants weighing ≤170 lbs. reported exacerbated pain. Veterans demonstrated higher daily prosthesis usage than the general population. Veterans with lower functional levels received prostheses predominantly from VA providers, while those with higher levels were referred to non-VA vendors, with no difference in issuance rate.

Despite higher risk for usage barriers, U.S. veterans showed increased prosthesis usage. Additional research may elucidate whether nutritional, strength, volume, or tissue differences affected the indirect worsening of pain with low body weight. Holistic peri-amputation care should address nutrition and health conditions to optimize functionality and wellness postamputation.Implications for RehabilitationLower extremity amputation is associated with detrimental and costly disorders that could be improved with increased lower extremity prosthesis use.Lower extremity amputation disproportionately affects U.S. veterans despite being underrepresented in the existing research concerning lower extremity prosthesis use and factors associated with changes in prosthesis usage.Clinicians should proactively encourage patients to maintain their health and fitness, even after experiencing a lower extremity amputation, to facilitate the use of prostheses.Rehabilitation professionals should tailor care plans to each veteran's unique medical, functional, and psychosocial profile rather than relying solely on demographic or clinical predictors.