Function and Quality of Life of Unilateral Major Upper Limb Amputees: Effect of Prosthesis Use and Type

Abstract

Objective: To compare patient-reported outcomes of disability, activity difficulty, and health-related quality of life (HRQOL) by prosthetic device use and configuration and to identify factors associated with these outcomes.

Design: Telephone survey.

Setting: General community.

Participants: Population-based sample of veterans (N=755) with unilateral upper limb amputation recruited from a national sample of veterans with upper limb amputation who received care at the Veterans Affairs clinic from 2010-2015.

Interventions: Not applicable.

Main outcome measures: Upper limb-related disability was measured using Disabilities of the Arm, Shoulder, and Hand score (QuickDASH). HRQOL was measured using the Veterans RAND 12-item Health Survey Mental and Physical Component scores. Activity difficulty was assessed for 1-handed and 2-handed tasks and by questions about the need for help with activities of daily living (ADLs).

Results: Patients who did not use a prosthesis had more difficulty performing 1-handed tasks using the residual limb as compared with those who used body-powered prostheses. Cosmetic device users had more task difficulty than body-powered or myoelectric users. Linear regression models did not show an association between type of prosthesis used and HRQOL scores, but did show that those who did not use a prosthesis (non-users) had worse QuickDASH scores (β=9.4; P=.0004) compared to body-powered users. In logistic regression modeling, the odds of needing help with ADLs were 1.84 times higher (95% confidence interval, 1.16-2.92) for non-users compared with body-powered users.

Conclusions: Amputees who did not use a prosthesis or used a cosmetic prosthesis reported more difficulty in activities and greater disability as compared with those who use body-powered and myoelectric devices. Non-users were more likely to need help with ADLs as compared with those who used a body-powered prosthesis. Our findings highlight the clinical importance of encouraging prosthesis use. Further research is needed to compare physical performance by prosthesis configuration.

Keywords: Amputation; Quality of life; Rehabilitation; Survey; Upper limb; Veterans.