AMPREDICT Mobility-4: A Novel Four Category Mobility Outcome Prediction Model for Patients Undergoing Vascular Amputation.

Objective: The aim of this study was to create a new mobility outcome prediction model (AMPREDICT Mobility-4) that can be applied at the time a decision is made that amputation is necessary due to an underlying vascular aetiology. It can be used to predict mobility outcome in patients undergoing transmetatarsal (TM), transtibial (TT), or transfemoral (TF) amputation.

Methods: A cohort study retrospectively identified persons with lower limb amputation (LLA) through a large Veterans Affairs dataset, then prospectively enrolled participants to obtain their 12 month post-amputation self reported mobility.

Frequency, severity, and implications of shoulder pain in people with major upper limb amputation who use prostheses: Results of a National Study.

Background: People with upper limb amputation are potentially at increased risk of shoulder pain because they often perform compensatory movements to operate their prostheses and rely more heavily on their nonamputated limb for everyday activities.

Objective: To describe the frequency, severity, associated factors, and implications of shoulder pain in people with unilateral major upper limb amputation who use prostheses.

Design: Cross-sectional, observational design.

The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.

Objective: Amputation level decision making in patients with chronic limb threatening ischaemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result is significant variation in the distribution of amputation levels across health systems, geographical regions, and time.

Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation: An Update from the Department of Veterans Affairs and Department of Defense.

Between 2015 and 2017, the US Department of Veterans Affairs and the US Department of Defense developed a clinical practice guideline for rehabilitation of lower limb amputation to address key clinical questions. A multidisciplinary workgroup of US Department of Veterans Affairs and US Department of Defense amputation care subject matter experts was formed, and an extensive literature search was performed which identified 3685 citations published from January 2007 to July 2016. Articles were excluded based on established review criteria resulting in 74 studies being considered as evidence addressing one or more of the identified key issues.

Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations.

Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions.

Reintegrating Veterans with Polytrauma into the Community and Workplace.

This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.

Department of Veterans Affairs Polytrauma Telerehabilitation: Twenty-First Century Care.

The use of telehealth for the management of the polytrauma patient provides a unique opportunity to leverage technology to enhance care for a complex patient cohort, to assist in clinical care, and to enhance support for community reintegration for veteran patients. Telehealth connects experts to patients in remote or underserved areas, thereby decreasing a health care disparity. This is especially important when the rehabilitation team is multidisciplinary.

Gait and Functional Outcomes for Young, Active Males With Traumatic Unilateral Transfemoral Limb Loss.

Objective: Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous studies describing these outcomes are typically limited by number of outcome measures and/or small, diverse patient groups, recent military conflicts present a unique opportunity to collect outcomes from a relatively homogenous, active patient population with limb loss.

Prosthetic fitting, use, and satisfaction following lower-limb amputation: a prospective study.

Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes.

Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study.

Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes.

The road to recovery and rehabilitation for injured service members with limb loss: a focus on Iraq and Afghanistan.

Amputation of an extremity due to traumatic injury or a vascular occlusive disease is a life-altering event that occurs when limb salvage is not possible. While an amputation is viewed as a life saving procedure clinically, limb deficiency may result in an immediate loss in social, physical and financial well-being for the patient. Military personnel returning from Operation Enduring Freedom and Operation Iraqi Freedom face unique challenges due to short residual limbs, unplanned amputations, high incidences of multiple limb loss, and accustomed activity levels prior to an amputation.

Incorporation of core competency questions into an annual national self-assessment examination for residents in physical medicine and rehabilitation: results and implications.

Objective: To determine the performance and change over time when incorporating questions in the core competency domains of practice-based learning and improvement (PBLI), systems-based practice (SBP), and professionalism (PROF) into the national PM&R Self-Assessment Examination for Residents (SAER).

Design: Prospective, longitudinal analysis.

Setting: The national Self-Assessment Examination for Residents (SAER) in Physical Medicine and Rehabilitation, which is administered annually.

Bioelectric analyses of an osseointegrated intelligent implant design system for amputees.

The projected number of American amputees is expected to rise to 3.6 million by 2050. Many of these individuals depend on artificial limbs to perform routine activities, but prosthetic suspensions using traditional socket technology can prove to be cumbersome and uncomfortable for a person with limb loss.

Effectiveness of resonance frequency in predicting orthopedic implant strength and stability in an in vitro osseointegration model.

Developing noninvasive tools that determine implant attachment strength to bone and monitor implant stability over time will be important to optimize rehabilitation protocols following insertion of osseointegrated implants in patients with limb loss. While resonance frequency has been previously shown to correlate with implant stability in dental implants placed in the mandible and maxilla, this tool has not been evaluated with implants placed in the medullary canal of long bones. In an in vitro model used to simulate irregular medullary canal implant contact and osseointegration, a strong positive correlation was determined between resonance frequency implant stability quotient values and the force required for implant pushout.

Research activities and perspectives of individuals completing a research enrichment program for physiatrists.

Objective: To investigate the research activity and perspectives, and the predictors and barriers to research activity, in a cohort of individuals completing a research enrichment program for physiatrists.

Design: A retrospective cohort study design was utilized. Data collection was accomplished with a mailed survey, which was sent to 68 individuals who had completed the Research Enrichment Program for Physiatrists between 1991 and 1998.