Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 4, 2010
   Pages 349 — 360

Abstract — Wheeled mobility: Factors influencing mobility and assistive technology in veterans and servicemembers with major traumatic limb loss from Vietnam war and OIF/OEF conflicts

Justin Z. Laferrier, MSPT, OCS, SCS, CSCS, ATP;1-3 Lynne V. McFarland, PhD;4-6 Michael L. Boninger, MD;1-2,7-8 Rory A. Cooper, PhD;1-3,7-8* Gayle E. Reiber, PhD, MPH 4-5

1Human Engineering Research Laboratories, Department of Veterans Affairs (VA) Rehabilitation Research and Development Service, Pittsburgh, PA; 2VA Pittsburgh Healthcare System, Pittsburgh, PA; 3Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; 4Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle WA; Departments of 5Health Services, 6Epidemiology, and 7Medicinal Chemistry, University of Washington, Seattle, WA; 8Department of Physical Medicine and Rehabilitation and 9Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

Abstract — Returning wounded veterans and servicemembers to their highest level of function following traumatic injury is a priority of the Departments of Defense and Veterans Affairs. We surveyed 245 veterans from the Vietnam war and 226 servicemembers and veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflicts with at least one major traumatic lower-limb loss to determine their use of mobility assistive technology (AT) and patterns of limb abandonment. Prosthetic device use without wheelchair use is found in 50.5% of Vietnam and 42.8% of OIF/OEF groups. Prostheses and supplementary wheelchairs are used by Vietnam (32%) and OIF/OEF (53%) groups (p < 0.01). Exclusive wheelchair use is more frequent in the Vietnam group (18%) than in the OIF/OEF group (4.0%, p < 0.01). In Vietnam participants, multivariate analysis found that multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.5-38.5), bilateral lower-limb loss (AOR = 12.7; 95% CI 6.2-26.1), and number of comorbidities (AOR = 1.3; 95% CI 1.2-1.5) are associated with increased likelihood of wheelchair use. In OIF/OEF participants, bilateral lower-limb loss (AOR = 29.8; 95% CI 11.0-80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1-85.3), cumulative trauma disorder (AOR = 2.4; 95% CI 1.2-4.9), and number of combat injuries (AOR = 1.4; 95% CI 1.2-1.7) are associated with wheelchair use. Combined use of different types of mobility ATs promotes improved rehabilitation and ability to function.

Key words: combat operations, mobility, mobility assistive technology, OIF/OEF, prosthetic device, rehabilitation, traumatic amputation, Vietnam, wheelchair, wounded servicemember.


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