Servicemembers and Veterans with Major Traumatic Limb Loss from Vietnam War and OIF/OEF Conflicts: Survey Methods, Participants, and Summary Findings

By Reiber, Gayle E.; McFarland, Lynne V. et al. | Journal of Rehabilitation Research & Development, July-August 2010 | Go to article overview

Servicemembers and Veterans with Major Traumatic Limb Loss from Vietnam War and OIF/OEF Conflicts: Survey Methods, Participants, and Summary Findings


Reiber, Gayle E., McFarland, Lynne V., Hubbard, Sharon, Maynard, Charles, Blough, David K., Gambel, Jeffrey M., Smith, Douglas G., Journal of Rehabilitation Research & Development


INTRODUCTION

The Department of Veterans Affairs (VA) was established to care for battle-injured veterans and their dependents. Restoring function to those with limb loss is one of the VA's highest priorities. Only 2 to 7 percent of servicemembers serving in prior conflicts returned to Active Duty after major limb loss [1-2]. A recent Department of Defense (DOD) Rehabilitation Directive is facilitating the return of servicemembers with major traumatic limb loss from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) to their highest possible functional level so that major limb loss does not prevent them from maximizing their career options in either the military or civilian sectors [3-5]. The DOD's Amputee Patient Care Programs at Walter Reed Army Medical Center, Washington, DC; Brooke Army Medical Center, San Antonio, Texas; and Naval Medical Center, San Diego, California, offer state-of-the-art rehabilitation, prostheses, assistive technologies, and training to restore function for servicemembers with limb loss to the extent possible [6]. The goal of early rehabilitation for servicemembers with traumatic limb loss in center-based comprehensive rehabilitation programs is to restore function and quality of life to the fullest extent possible and provide state-of-the-art prostheses, wheeled mobility, and other assistive devices.

The mortality among servicemembers injured in combat decreased from 24 percent in the Vietnam war to approximately 20 percent in OIF/OEF. This is largely attributed to changes in protective gear and equipment, immediate battlefield triage, and forward surgical teams linked to comprehensive care [7-8]. The total number of servicemembers with traumatic limb loss from the Vietnam war is estimated at 3.4 percent of battle injured or 5,283 individuals [9]. This compares with 2.6 percent of battle injured with limb loss or nearly 1,000 individuals to date in OIF/OEF. **

Following limb loss, adjusting to life with a prosthesis and other mobility technologies is a complex rehabilitation process. Each day, individuals with limb loss balance issues of pain and physical and psychological limitations with decisions about activities of daily living (ADLs), use of prostheses, adaptive devices, and wheeled mobility. Over time, those with limb loss select and use prosthetic devices and other technologies that maximize their function and conserve their time. Some Vietnam war veterans with major traumatic limb loss are now interested in trying new, technologically advanced, or specialty prosthetic devices to improve their function and increase their participation in recreational activities, while some OIF/OEF servicemembers and veterans are simplifying the number of prosthetic devices they use on a regular basis to minimize prosthetic burden.

It is important to forecast shifts in prosthetic use and associated costs since the VA prosthetic limb distribution policy allows veterans with limb loss to receive any prosthesis requested if it is deemed medically and functionally indicated. ([dagger]) Therefore, the purpose of this article is to summarize findings from Vietnam war veterans and OIF/ OEF veterans and servicemembers with traumatic limb loss who completed the Survey for Prosthetic Use (Appendix 1 , available online only) and to identify issues of importance to servicemembers, veterans, and the agencies caring for them.

METHODS

Survey Participants

Our goal was to include all eligible OIF/OEF servicemembers with traumatic limb loss and an equivalent number of Vietnam war veterans, oversampling to include all those with unilateral upper-limb loss and multiple limb loss. We enrolled 298 veterans from the Vietnam war and 283 servicemembers and veterans from OIF/OEF [10]. A glossary of study terms and definitions is located at the end of this issue [11].

Vietnam War Participants

We identified veterans aged 50 to 80 who sustained major traumatic limb loss in the Vietnam war combat theater (1961-1973) and received service-connected disability benefits for limb loss using VA Compensation and Pension Mini Master files in Austin, Texas. …

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