Identifying the magnitude and impact of pelvic floor disorders in Veterans with lower limb amputation

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Pelvic floor disorders (PFDs) is the broad term used to describe a number of impairments that affect millions of women and men in the U.S. Symptoms of PFDs resulting from over- or underactivity of pelvic musculature manifest in a variety of ways, including urinary and fecal incontinence, urinary frequency or urgency, as well sexual dysfunction and pelvic pain syndromes. Pelvic floor disorders are poorly understood in people with physical disabilities, and Veterans with lower limb amputation (LLA) are one such group of individuals. Pelvic floor disorders are effectively managed with conservative, non-pharmacological treatment, but left undiagnosed can adversely affect many facets of functioning and well-being. People with LLA frequently exhibit conditions associated with PFDs in the non-LLA population, including low back pain and heightened fall risk, yet the presence of PFDs have not been systematically assessed in individuals with LLA. With over a million people living with LLA in the U.S., this may pose a significant health burden that is currently not being addressed. The overall objective of this proposal is to better understand the magnitude and impact of PFDs on health-related quality of life in Veterans with LLA. We will explore the prevalence of PFDs amongst men and women with LLA and the physical and behavioral sequalae associated with the presence of symptoms of PFDs. We propose to comprehensively address the gaps in knowledge by administering surveys, including psychometrically sound outcome measures, to assess symptoms of PFDs, to 200 study participants of both sexes (n ≥ 100 females). All surveys will be remotely administered to participants, to optimize convenience and study enrollment. Our proposed study has three aims: Specific Aim 1: To estimate the prevalence of PFDs in a cohort of male and female Veterans with LLA. This descriptive aim will provide seminal data on the magnitude of PFDs in Veterans with LLA and can serve as a proxy estimate for rates in the LLA population in general. Estimates will be provided based on sex and level of LLA (trantibial, transfemoral, etc.) The primary measure of PFD symptoms will be the Pelvic Floor Distress Inventory (PFDI-20), with secondary measures administered to explore other aspects related to PFDs in men and women. Furthermore, this aim will assess the feasibility of collecting self-reported pelvic/urogenital information and the acceptability by Veterans to PFD-related survey items. Specific Aim 2: To examine associations between PFDs and low back pain, and prosthetic mobility in Veterans with LLA. This aim is designed to determine physical sequelae related to the presence of PFDs. We expect that (2A) there will be significant relationships between PFDs and scores on the Oswestry Disability Index as a measure of low back pain, and (2B) lower scores of prosthetic mobility, as measured by the Prosthetic Limb Users Survey of Mobility™ will be associated with PFDs. Specific Aim 3: To examine the extent to which PFDs contribute to fall risk and levels of activity participation in Veterans with LLA. This aim will examine the impact of reported PFDs relative to behavior constructs affecting health-related quality of life. We anticipate that (3A) there will be significant levels of association between PFDs with reported fall occurrence, and that (3B) the presence of PFDs will be associated with decreased activity participation, both social and work related. Impact. Successful completion of this work will establish an evidence base regarding PFDs in male and female Veterans with LLA. This SPiRE presents an opportunity to shift the paradigm of LLA rehabilitation by elevating the consideration of often-ignored variables that could be contributing to increased rates of falls, low back pain, and poorer quality of life in this population.