Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study.

Publisher: Oxford University Press Country of Publication: United States NLM ID: 0022623 Publication Model: Print Cited Medium: Internet ISSN: 1538-6724 (Electronic) Linking ISSN: 00319023 NLM ISO Abbreviation: Phys Ther Subsets: MEDLINE

Publication: 2017- : New York : Oxford University Press
Original Publication: Alexandria, VA : American Physical Therapy Association

Military Personnel*/statistics & numerical data ; Upper Extremity*/physiopathology ; Upper Extremity*/injuries ; Disability Evaluation*; Humans ; Male ; Female ; Adult ; Longitudinal Studies ; United Kingdom ; Lower Extremity/injuries ; Afghan Campaign 2001- ; Amputees/rehabilitation ; Cohort Studies ; Amputation, Surgical/rehabilitation ; Amputation, Surgical/statistics & numerical data

Objective: Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.
Methods: A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.
Results: DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.
Conclusion: People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.
Impact: For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

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ADV-H4H-01 ADVANCE

Keywords: Amputation; Anatomy: Lower Extremity; Anatomy: Upper Extremity: Arm; Anatomy: Upper Extremity: Hand; Anatomy: Upper Extremity: Shoulder; Blast Injuries; Military Personnel; Musculoskeletal Diseases

Date Created: 20240702 Date Completed: 20241021 Latest Revision: 20241023

20241023

PMC11491512

10.1093/ptj/pzae082

38952004