Full-text articles are available at http://www.rehab.research.va.gov/jour/10/474/contents.html

Manuscripts featured in this issue include—

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings, pg. 275

This article summarizes findings from the Department of Veterans Affairs’ (VA’s) Survey for Prosthetic Use—the first national survey of veterans who sustained major traumatic limb loss during the Vietnam and Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflicts. The findings indicate the vast majority of these combat-injured servicemembers and veterans report good health status and adjustment following limb loss. The highest health status is reported by participants from both conflicts with multiple limb loss: 81.9 percent in Vietnam war and 90.2 percent in OIF/OEF participants. Chronic healthcare issues identified by study participants with traumatic limb loss are persistent pain (back, phantom limb, and residual limb), skin problems, and psychological issues.

Unilateral upper-limb loss: Satisfaction and prosthetic-device use in veterans and servicemembers from Vietnam and OIF/OEF conflicts, pg. 299

Prosthetic-device use is described in two groups with combat-associated unilateral upper-limb loss. Of those in the Vietnam group, who have more experience with prosthetic devices, 70 percent continue to use upper-limb prostheses, even 38 years after undergoing amputation. In the OIF/OEF group, 77 percent use upper-limb prostheses; however, they use three times as many as the Vietnam group and use more technologically advanced devices. This article explores reasons why prosthetic devices have been abandoned and presents recommendations to improve the care of individuals with upper-limb loss.

Unilateral lower-limb loss: Prosthetic device use and functional outcomes in servicemembers from Vietnam war and OIF/OEF conflicts, pg. 317

This study documents the use and satisfaction of Vietnam and OIF/OEF veterans with lower-limb prostheses for restoring functional capability. In a survey of 350 veterans with unilateral lower-limb loss, 84 percent of the Vietnam group and 94 percent of the OIF/OEF group report using at least one prosthetic device. Prostheses abandonment is infrequent: 11 percent in the Vietnam group and 4 percent in the OIF/OEF group. Reasons for rejection varied by type of device but include pain, weight, and poor fit.

Multiple traumatic limb loss: A comparison of Vietnam veterans to OIF/OEF servicemembers, pg. 333

Researchers compare changes in health status, prosthetic-device use, and long-term prognosis of Vietnam and OIF/OEF veterans with combat-associated multiple limb loss. Level of functional ability was significantly lower in the Vietnam group. One-third of participants in the Vietnam group were nonambulatory. By comparison, only 7 percent of the OIF/OEF group were nonambulatory.

Wheeled mobility: Factors Influencing mobility and assistive technology in veterans and servicemembers with major traumatic limb loss from Vietnam war and OIF/OEF conflicts, pg. 349

This study evaluates use of mobility assistive technology among veterans with lower-limb loss and patterns of prosthesis abandonment. Study results indicate that the majority of study participants use a combination of assistive technology for mobility. Prostheses and supplementary wheelchairs are used by 32 percent of Vietnam and 53 percent of OIF/OEF participants. Exclusive wheelchair use is approximately four times more frequent in the Vietnam group than in the OIF/OEF group.

Comparison of satisfaction with current prosthetic care in veterans and servicemembers from Vietnam and OIF/OEF conflicts with major traumatic limb loss, pg. 361

In a survey of 581 veterans and servicemembers with limb loss from the Vietnam and OIF/OEF conflicts, 78.2 percent from the Vietnam conflict and 90.5 percent from the OIF/OEF conflict currently use prosthetic devices. Among Vietnam respondents, 78 percent received prosthetic care from private sources, 16 percent from VA prosthetic laboratories, 0.9 percent from Department of Defense (DOD), and 5 percent from multiple sources. Among OIF/OEF respondents, 42 percent received prosthetic care from private sources, 9 percent from VA, 39 percent from DOD, and 10 percent from multiple sources. Factors that correlated with decreased prosthetic satisfaction included poor socket fit, poor prosthesis fit, difficulty getting repairs or replacements when needed, lack of involvement in choosing the type of device, desire to change to another type of prosthetic device, lack of satisfaction with training, and skin problems.

Quality of life for veterans and servicemembers with major traumatic limb loss from Vietnam and OIF/OEF conflicts, pg. 373

The authors surveyed overall quality of life (QOL) in veterans and servicemembers wounded in the Vietnam war and OIF/OEF conflicts. Vietnam participants with higher QOL scores were satisfied with their current prostheses, had less depression, and felt their limb loss has less effect on their current life. OIF/OEF participants with higher QOL reported fewer combat injuries, fewer injuries to their nonamputated limb, and less need for assistance with daily activities.

Prosthetic cost projections for servicemembers with major limb loss from Vietnam and OIF/OEF, pg. 387

This study provides the VA a funding estimate for ongoing rehabilitation of veterans with traumatic limb loss from the Vietnam and OIF/OEF conflicts. Projected cost estimates are based on the current use of these devices by respondents to the national survey. Average projected costs for the Vietnam group were found to be lower than for the OIF/OEF cohort due in part to their use of fewer and less technologically advanced prosthetic devices and higher frequency of prosthetic abandonment.

Department of Veterans Affairs compensation and medical care benefits accorded to veterans with major limb loss, pg. 403

The researchers describe the characteristics of, compensation received, and medical care benefits used by veterans with service-connected disability for limb loss. Of the 2,690 veterans who in August 2007 received compensation for loss of one or more limbs, more than 97 percent sustained their injuries in Vietnam; most were young men who served in the U.S. Army or Marine Corps, all but 5 percent had at least 50 percent combined service-connected disability, and nearly half had a 100 percent rating. Additionally, one of the most prevalent compensable conditions was posttraumatic stress disorder, present in 46 percent of OIF/OEF and 20 percent of Vietnam veterans.

JRRD is a peer-reviewed, scientifically indexed journal providing comprehensive coverage of all rehabilitation disciplines. It provides researchers and other rehabilitation professionals with the ideal venue for publishing original research papers for exposure to a global audience. For more information about JRRD, please visit www.rehab.research.va.gov.

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JRRD Volume 47, Issue 4