Improving Acceptability and Outcomes for Upper Extremity Transplantation in Service Members and Veterans
Abstract
Upper limb loss is common in civilians, Veterans, and Service members in the United States, with more than 541,000 individuals currently living with such an amputation. While some of the causes overlap (e.g., gunshot wounds, motor vehicle accidents), the circumstances under which these injuries occur can be quite different. Similarly, the way in which Veterans and Service members view their limb loss and treatment options can differ, and it is important to understand patient-reported concerns in order to best meet individuals’ treatment needs. While prosthetics are the most common way to restore function to people missing hands or arms, another treatment is available to certain candidates: hand or arm transplantation. Although transplantation has the ability to restore the body almost immediately, return of function and sensation can take months to years, depending on the patient’s amputation level and faithful participation in physical therapy. Transplant patients must also take immunosuppressive medications to keep themselves and their transplanted limb(s) healthy; however, these medicines have side effects and can cause health problems when used over many years. These factors amount to a procedure with considerable costs and benefits whose relative value can vary greatly between individuals. Several studies of civilians with and without upper limb loss have been done to discover opinions on hand/arm transplantation. However, little is known about the opinions of Veterans and Service members with upper limb loss regarding hand/arm transplantation and the relative value they place on this treatment compared to reconstruction or prosthetics. Therefore, we propose to study Veterans and Service members with upper limb loss to better understand their opinions of and the relative value they place on hand and arm transplantation, given its potential risks and benefits. In this way, we hope to better target hand and limb transplantation to candidates who are the most likely to do well after transplant. Under this proposal, we will study three aims: Specific Aim 1. Identify psychosocial factors related to the acceptability and barriers to UE transplantation from Service members and/or Veterans with upper extremity amputations. 1a. Identify the most important factors for each UE amputee group. (Upper limb loss on one or both sides, and below- or above-elbow loss for patients missing part of one upper limb). 1b: Compare the most important factors for each group to the other groups to determine overlap and group-specific factors . Specific Aim 2. Identify psychosocial factors related to the acceptability and barriers to upper extremity transplantation and recovery in Service members and/or Veterans who underwent UE transplantation. 2a: What psychosocial factors are important to upper extremity transplant recipients? 2b: In what ways are important psychosocial factors for UE transplant recipients and Veteran and Service member UE amputees similar or different? Specific Aim 3. Quantify the value and benefits Service member and/or Veteran UE amputees attribute to UE transplantation. We will study the perceived value and barriers reported by Service members and Veterans with loss of one or both upper limbs regarding hand/arm transplantation using a series of online surveys that will help patients list and rank the factors they find most or least important (modified Delphi iterative design (Aim 1). We will also interview Veterans and Service members who have undergone reconstructive transplantation to see what factors they think have helped them do well with the transplant or have contributed to challenges (Aim 2). Then we will use these data to assess how Veterans and Service members value hand/arm transplantation compared to prosthetics or no treatment by having them choose between different hypothetical scenarios (discrete choice experiment) (Specific Aim 3). Data will be analyzed descript
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010507
Entities
People
- Zeeshan Butt
Organizations
- Northwestern University
- United States Army