Comparative Effectiveness of Upper Limb Prostheses and Component Effects
Abstract
Rationale: There are many upper limb prostheses and componentry options; however, it is unclear how to best match an individual patient with a particular device type or component. Studies that compare the effectiveness of different prostheses types and components are lacking. Research is needed to fill these knowledge gaps. Objective: The overall objective of this study is to generate evidence to guide prosthesis prescription by comparing effectiveness of upper limb prostheses and components and whether specific groups of patients are more likely to benefit from specific device types or components. Specifically, it will compare types of prostheses (body-powered, myoelectric/hybrid) as well as properties and features of devices and components including prosthetic wrists, terminal devices, and suspension methods, and will evaluate the impact of terminal device appearance and weight. Applicability and Potential Impact: This study will provide data to guide prescription of upper limb prostheses that will be directly useful to the Veteran and military health system and to the wider civilian sector. The study will provide information on the impact of prosthesis type, form, and socket interfaces, and will evaluate whether there are subgroups of patients who are most likely to benefit from specific devices and components. Comparisons between device and component types will be made using a range of outcomes that are important to persons with amputation including: ability to manipulate small objects and perform daily tasks, amount of prosthesis use, perceived difficulty in performing activities, satisfaction with the prosthesis and quality of life. The findings will help guide prosthesis prescription and inform policies regarding prosthesis provision and will directly benefit persons with major upper limb amputation at the transradial and transhumeral level. Patient Population and Clinical Applications: There are more than 50,000 persons with upper limb amputation in the U.S. and more than 3,200 Veterans with major upper limb amputation who receive care through the Department of Veterans Affairs (VA). There have been nearly 300 wounded Warriors from recent wars who have had major upper limb amputation. While Veterans and Service members with limb loss have better access to prosthetic devices as compared to persons in the civilian sector, the prosthesis abandonment rate among Veterans and Service members is high. Many with upper limb amputation suffer from chronic pain, phantom limb pain, and pain of the stump. Pain is a limiting factor for many prosthesis users, causing some to restrict use of the devices. Others abandon or limit their device use because of poor functioning. Better matching of amputees with prostheses may improve use of and function with prostheses. Timeline: This study will be completed in a 3-year timeline. Data collection processes and procedures are already established, and data collection activities will begin after regulatory approvals and staff training in the first quarter of funding. Data collection will be completed in 2 years, and data analysis and reporting will be conducted throughout years 2 and 3. Findings will be disseminated widely to clinical and scientific communities. Military Benefit: This study will be the largest, most comprehensive, study comparing upper limb prostheses and components. It combines the strength of cross-agency VA and Department of Defense investigative teams and builds on an existing study to allow comparisons of outcomes for approximately 300 upper limb prosthesis users. Appropriate provision of prostheses that optimally matched to persons will improve device satisfaction, reduce abandonment rates, and improve overall quality of life of amputees. Findings will be harnessed to improve the quality of care in the Veteran and military healthcare systems and beyond.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910800
Entities
People
- Linda Resnik
Organizations
- Ocean State Policy Research Institute
- United States Army