Needs, Preferences and Functional Abilities of Veterans and Service Members with Upper Limb Amputation

上肢截肢退伍军人和现役军人的需求、偏好和功能能力

• 批准号: 9421582
• 负责人: LINDA J. RESNIK
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9421582
• 关键词: Activities of Daily Living; Amputation; Amputees; Books; Caring; Clinical Practice Guideline; Data; Data Collection; Devices; Elements; Emerging Technologies; Female; Gender; Measures; Military Personnel; Modification; Nature; Neck Pain; Outcome; Patient Self-Report; Pattern; Performance; Persons; Physical Function; Physical Performance; Policies; Population; Private Sector; Prosthesis; Quality of Care; Quality of life; Recommendation; Rehabilitation therapy; Reporting; Research; Research Design; Respondent; Risk; Risk-Benefit Assessment; SF-12; Sampling; Services; Site; Source; Surveys; Testing; Time; Upper Extremity; Veterans; Weight; Woman; base; care systems; combat; dexterity; disability; evidence base; evidence based guidelines; follow-up; geographic difference; improved; limb amputation; male; preference; rehabilitation service; response; satisfaction; service member; standardize measure; transradial amputee

BACKGROUND Quality gaps in care of military and Veterans with upper limb amputation have been reported. In 2008, amputees receiving prosthetic care in the VA were reported to be less satisfied than counterparts receiving care in the private sector. In 2011, reported widespread dissatisfaction amongst combat Veterans with upper limb loss led to calls for efforts to evaluate needs of Veterans with traumatic upper limb amputations to improve satisfaction. Major efforts to improve quality of prosthetic care have been made since these studies were conducted. In 2009, the VA reorganized its amputation system of care, and in 2014 the VA and DOD released the Evidence-Based Clinical Practice Guidelines (CPGs) for the rehabilitation of persons with upper limb amputation. It is now time for a comprehensive study to assess the current state of quality and outcomes of amputation rehabilitation for upper limb amputees and to track quality and outcomes over time. OBJECTIVES Our objective is to provide comprehensive cross-sectional and longitudinal data on function, needs, preferences, and satisfaction of Veterans and service members with major upper limb amputation. This project modification adds subaims 1a and 2a to provide comprehensive data on women Veterans with upper limb amputation. SPECIFIC AIMS/HYPOTHESES 1) Describe patterns of prosthesis use; identify the impact of amputation and prosthesis use on function, activities and participation; and identify unmet prosthetic needs This aim will test 5 major hypotheses: 1) rates of prosthesis use and scores on prosthesis satisfaction scales will be higher for transradial (TR) amputees as compared to persons with more proximal amputations ; 2) there will be higher rates of prosthesis use and satisfaction amongst those with amputation in the past 5 years as compared to those who sustained amputation 6 or more years ago; 3) any prosthesis use, and myoelectric use will be associated with lower ratings of disability and neck pain compared to no prosthesis use and body-powered use respectively; 4) perceived difficulty of everyday activity function will be rated similarly for persons with unilateral upper limb amputation regardless of level, with no differences between users by type of prosthetic device. However, perceived difficulty in performing activities that require bimanual involvement will be greater for persons with more proximal as compared to TR amputation; 5) a greater proportion of activities will be performed using the prosthesis by persons with TR amputation as compared to more proximal amputation. 1a. Compare findings by gender. This sub aim will test the hypotheses that there will be an effect modification by gender, with female upper limb amputees being less satisfied with their prosthesis regardless years since amputation, 2) Conduct a one year longitudinal follow-up survey to examine changes in satisfaction with care and prosthetic services, physical performance, self-reported quality of life and physical function to assess the implementation of new clinical practice guidelines (CPGs). This aim will test the following associated hypotheses: 1) There will be geographic variation in VA compliance with CPG recommendations with amputation related services that parallels findings from prior research; 2) There will be improvements over time in satisfaction with care for upper limb amputees receiving care at the VA and DoD but not for Veterans receiving care from other sources; and 3) There will be improvements over time in indicators of CPG compliance. 2a. Compare findings by gender. This sub aim would test the hypotheses 1) that there will be no differences between compliance with CPG recommendations between male and female Veterans with upper limb amputation, and 2) there will be no differences between female and male Veterans’ satisfaction with quality of care. 3) Quantify physical function using a battery of performance based tests. This aim is descriptive in nature, and thus there are no associated hypotheses. STUDY DESIGN This is a 3-part study. Part 1 will survey a stratified random sample of 1850 of persons with upper limb amputation that receive care in the VA and all service members with upper limb amputation who have not transitioned to VA care. This N represents ~41% of the population, which is 97% male. We will stratify by level of amputation, oversample the smallest groups, and use sampling weights in analyses. For the expansion of this project, we propose sampling ALL female Veterans with major upper limb amputation, which we estimate, based on 2016 VA amputation briefing book would be 130 additional subjects in our study. The survey will include items from prior surveys, standardized measures (SF-12, QuickDASH, TAPES satisfaction, and OPUS care satisfaction) and new items on risk-benefit assessment, and elements of quality. Part 2 is a one year longitudinal follow-up survey of 667 respondents from Part 1 and an estimated 80 female respondents (given that we anticipate a 61% response rate). Part 3 will involve 5 data collection sites that will administer measures of dexterity and activity performance to 125 persons at two time points one year apart.

背景：军人和退伍军人上肢截肢护理的质量差距已有报道。 2008年，在退伍军人管理局接受假肢护理的截肢者被报道的满意度低于同行。 在私营部门接受护理。2011年，据报道，退伍军人中普遍存在不满 上肢丧失导致呼吁努力评估创伤性上肢截肢退伍军人的需求 以提高满意度。自这些研究以来，为提高假肢护理的质量作出了重大努力 都进行了测试。2009年，退伍军人事务部重组了其截肢护理系统，2014年退伍军人事务部和国防部 发布以证据为基础的临床实践指南(CPGs)，用于上肢患者的康复 截肢。现在是时候进行一项全面的研究，以评估目前的质量和成果状况 评估上肢截肢者的截肢康复情况，并跟踪其质量和随时间推移的结果。 我们的目标是提供关于功能的全面的横断面和纵向数据， 退伍军人和上肢大截肢军人的需求、偏好和满意度。这 项目修改增加了次级目标1a和2a，以提供关于患有老年人的退伍军人的全面数据 截肢。 具体目标/假设 1)描述假体使用模式；确定截肢和假体使用对以下方面的影响 功能、活动和参与度；以及确定未满足的假肢需求这个目标将测试5个主要 假设：1)假体使用率和假体满意度得分越高， 与更多近端截肢者相比，经桡骨截肢者的比例更高；2) 过去5年截肢者假体使用率和满意率的比较 6年或以上曾接受截肢的人；3)任何假体使用和肌电使用将是 与不使用假肢和使用身体动力相比，残疾和颈部疼痛的评级较低 4)单侧患者的日常活动功能知觉困难程度与单侧患者相似 上肢截肢不分节段，不同义肢类型的使用者之间没有差别。 然而，在执行需要双手参与的活动时，感觉到的困难将会更大 截肢比截肢更接近的人；5)更大比例的活动将是 与更近端截肢的人相比，使用假体的人使用TR截肢者。 1A.按性别比较调查结果。这个子目标将检验将会产生影响的假设 按性别进行修改，女性上肢截肢者对其假肢不太满意 不管截肢后有多少年， 2)进行一年的纵向跟踪调查，以检查护理和护理满意度的变化 假体服务、身体性能、自我报告的生活质量和身体功能的评估 实施新的临床实践指南(CPGs)。这一目标将测试以下相关的 假设：1)退伍军人事务部在遵守CPG建议方面会有地理差异 截肢相关服务，与先前研究的结果相似；2)随着时间的推移，将会有改进 对上肢截肢患者在退伍军人管理局和国防部接受护理而不是退伍军人的护理感到满意 接受其他来源的照顾；以及3)随着时间的推移，中央人民政府的指标将有所改善 合规性。 2A。按性别比较调查结果。这一次目标将检验假设1)将不会有 退伍军人对CPG建议依从性的性别差异 上肢截肢，以及2)女性和男性退伍军人之间没有差异 对护理质量的满意度。 3)使用一系列基于性能的测试来量化身体功能。这一目标在 自然，因此没有相关的假设。 研究设计本研究分为三部分。第一部分将对1850名符合以下条件的人进行分层随机抽样 在退伍军人管理局接受护理的上肢截肢和所有接受上肢截肢的军人 尚未过渡到退伍军人管理局护理。这个N代表大约41%的人口，其中97%是男性。我们将分层 根据截断程度，对最小的组进行过抽样，并在分析中使用抽样权重。对于 这个项目的扩展，我们建议对所有接受严重上肢截肢的女性退伍军人进行抽样，这是 我们估计，根据2016年退伍军人管理局截肢简报，我们的研究将增加130名受试者。这个 调查将包括以前调查的项目、标准化测量(SF-12、QuickDASH、磁带满意度、 和业务护理满意度)和关于风险-效益评估的新项目，以及质量要素。第2部分是 第一部分对667名受访者进行了为期一年的纵向跟踪调查，估计有80名女性 受访者(鉴于我们预计回复率为61%)。第3部分将涉及5个数据收集站点，它们将 在相隔一年的两个时间点对125人进行灵巧度和活动表现的测量。