Posted April 28, 2023
Dr. Roxanne Disla, Department of Veterans Affairs (VA) New York Harbor Health Care System
Dr. Roxanne Disla (Photo Provided)
The Orthotics and Prosthetics Outcomes Research Program (OPORP) funds clinical research intended to improve our understanding and prescription practices of orthotic and prosthetic (O&P) devices for optimal outcomes. Several device factors such as material, fit, weight, aesthetics, and others will impact outcomes. Clinicians know firsthand that patient-related factors such as physical preferences, motivation, satisfaction, and others also significantly influence outcomes. The OPORP and other federal and non-federal funders have expressed interest in better understanding which factors lead to successful O&P outcomes and why. One such factor is gender.
Thirty-five percent of the current population with limb loss is female1, yet women with limb loss have been historically studied less than men with limb loss. Women Veterans with limb loss have grown in number and proportion, increasing by 28% from 2,049 to 2,622 from 2015 to 20192. Women with limb loss generally require smaller prosthetic components due to their smaller bone structure and muscle mass; however, commercially available prosthetic components tend to be designed with male proportions and biomechanics in mind, leading to greater dissatisfaction with prosthetic fit for women. Due to the lack of female-specific components, the heavy prosthetic weight can lead to skin integrity problems, pistoning within the prosthetic socket, and an increased risk for secondary comorbidities (such as osteoarthritis). In addition to gender-specific physical challenges, women with limb loss also face unique psychosocial challenges. There is growing evidence that, following limb loss, women are more likely to experience depression than men3 and have greater difficulty with emotional adaptation to role changes4-5. The psychosocial adaptation of women to limb loss has not been well addressed in existing literature. It is critically important to understand the psychological adjustment needs to create effective treatment strategies for this underserved population.
With funding from a fiscal year 2016 (FY16) OPORP Prosthetic Outcomes Research Award, Dr. Roxanne Disla and her team at VA New York Harbor Healthcare System, New York University, and Walter Reed National Military Medical Center conducted a national exploratory needs assessment that focused on determining the unique physical and psychosocial needs of women with limb loss. The study team developed and distributed a comprehensive online survey that included questions addressing physical health, quality of life, prosthetic use and needs, and psychosocial experiences. Veterans, Service Members, and civilians with limb loss were invited to take the online survey.
By the end of the study enrollment period, 231 (128 female and 103 male) participants completed the survey. Of the 231 participants, 26 were female Veterans/Service Members and 48 were male Veterans/Service Members. Preliminary analysis of physical needs revealed that women with limb loss reported worse residual limb health compared to men but had significantly fewer activity restrictions. For psychosocial needs, preliminary analysis indicated that women with limb loss were less satisfied with appearance compared to men and reported less ease in social situations, higher anxiety and depression, and worse body image perception when compared to male survey respondents.
This newly developed survey-based needs assessment represents the first tool to combine population-specific physical and psychosocial assessments, as well as additional items that current measures are not sensitive enough to capture.
The population of women with limb loss, specifically in the VA and Department of Defense (DOD) health care systems, is growing, and this research study is enhancing our understanding of the unique needs of this population. During recent conflicts, more than 600 American Servicewomen were injured, and 27 experienced traumatic limb amputation (Extremity Trauma and Amputation Center of Excellence Data Repository, August 2016). From 2015 to 2019, the population of female Veterans with limb loss rose from 2% to 3% of the total limb loss population. To meet their needs, providers for women with limb loss must evolve their health care delivery and research practices, and work jointly with manufacturers who create prosthetic devices. Through this joint VA and DOD collaboration, Dr. Disla and her team helped to bridge the knowledge gap to meet the specific needs of women with limb loss.
Dr. Disla and her team plan to further disseminate results through the VA network by presenting at the Amputation System of Care Ground Rounds in May 2023, as well as providing a presentation at the American Congress for Rehabilitation Medicine Conference in October 2023. Dissemination of these novel research results has the potential to directly impact health care provided to all women with limb loss by enabling more evidence-based prescription of service and influencing clinical practice guidelines.
1Ziegler-Graham K et al. 2008. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation 89(3):422-9.
22020. U.S. Government Accountability Office. Veterans Health Care: Agency efforts to provide and study prosthetics for small but growing female veteran population. Washington, D.C. https://www.gao.gov/assets/720/710600.pdf.
3Kashani JH, Frank RG, Kashani SR, et al. 1983. Depression among amputees. The Journal of Clinical Psychiatry 44(7):256–58. PMID:6863225.
4Pezzin LE, Dillingham TR and MacKenzie EJ. 2000. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Archives of Physical Medicine and Rehabilitation 81(3):292–300. PMID:10724073. http://dx.doi.org/10.1016/S0003-9993(00)90074-1.
5O’Toole DM, Goldberg RT, and Ryan B. 1985. Functional changes in vascular amputee patients: evaluation by Barthel Index, PULSES profile and ESCROW scale. Archives of Physical Medicine and Rehabilitation 66(8):508–11. PMID:4026551.
Last updated Friday, April 28, 2023