A National Survey of Prosthesis Use in Veterans with Major Upper Limb Amputation: Comparisons by Gender

Background A better understanding of women veterans with upper limb amputation is needed. Objective To compare prosthetic use and outcomes of female and male veterans with upper limb amputation. Design Cross-sectional survey: Amputation characteristics, prosthesis use, and quality of life outcomes were compared by gender. Separate logistic regression models examined association of gender with prosthesis use and receipt of training to use a prosthesis. Separate linear regression models examined the relationship between gender and health-related quality of life (HRQoL) outcomes. Participants Participants were veterans with major upper limb amputation who received care at the Department of Veterans Affairs (VA) in 2010-2015, identified from VA data sources. A total of 808 individuals (755 men, 21 women) were surveyed by telephone. Main Outcome Measures Disabilities of the Arm, Shoulder and Hand (QuickDASH), VR-12 Physical Component Summary (PCS) and VR-12 Mental Component Summary (MCS), Trinity Amputation and Prosthetic Experience Scale satisfaction scale, Orthotics and Prosthetic User's Survey client satisfaction with devices scale. Setting Telephone survey of community dwelling participants. Interventions Not applicable. Results Survey response rate was 47.3% for men and 62.8% for women. Women were less likely to have ever used a prosthesis (adjusted odds ratio [aOR] = 0.26; confidence interval [CI] 0.08-0.88), have received training for an initial prosthesis (aOR: 0.24; CI 0.08-0.70), be current users (aOR = 0.34; CI 0.12-1.01), and have received training for a current prosthesis (aOR: 0.15; 0.03-0.87). A greater proportion of women used cosmetic and a smaller proportion used body-powered devices compared to men (P < .05). Device heaviness or fatigue was the most common reason for abandonment. There were no significant differences in outcome measures by gender. Conclusions Women were less likely than men to have ever used and currently use prostheses or to have received prosthetic training, more likely to use cosmetic devices, and less likely to use body-powered devices. Efforts to develop prostheses that are cosmetically acceptable, yet lightweight and functional, are needed.