title: Wheeled mobility: factors influencing mobility and assistive technology in veterans and servicemembers with major traumatic limb loss from Vietnam war and OIF/OEF conflicts.
abstract: Returning wounded veterans and servicemembers to their highest level of function following traumatic injury is a priority of the Departments of Defense and Veterans Affairs. We surveyed 245 veterans from the Vietnam war and 226 servicemembers and veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflicts with at least one major traumatic lower-limb loss to determine their use of mobility assistive technology (AT) and patterns of limb abandonment. Prosthetic device use without wheelchair use is found in 50.5% of Vietnam and 42.8% of OIF/OEF groups. Prostheses and supplementary wheelchairs are used by Vietnam (32%) and OIF/OEF (53%) groups (p < 0.01). Exclusive wheelchair use is more frequent in the Vietnam group (18%) than in the OIF/OEF group (4.0%, p < 0.01). In Vietnam participants, multivariate analysis found that multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.5-38.5), bilateral lower-limb loss (AOR = 12.7; 95% CI 6.2-26.1), and number of comorbidities (AOR = 1.3; 95% CI 1.2-1.5) are associated with increased likelihood of wheelchair use. In OIF/OEF participants, bilateral lower-limb loss (AOR = 29.8; 95% CI 11.0-80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1-85.3), cumulative trauma disorder (AOR = 2.4; 95% CI 1.2-4.9), and number of combat injuries (AOR = 1.4; 95% CI 1.2-1.7) are associated with wheelchair use. Combined use of different types of mobility ATs promotes improved rehabilitation and ability to function.
authors.affiliation: Human Engineering Research Laboratories, Department of Veterans Affairs (VA) Rehabilitation Research and Development Service, Pittsburgh, PA 15206-1206, USA.
authors.forename: Justin Z
authors.initials: JZ
authors.lastname: Laferrier
authors.forename: Lynne V
authors.initials: LV
authors.lastname: McFarland
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
authors.forename: Rory A
authors.initials: RA
authors.lastname: Cooper
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
mesh_terms: D000203:Activities of Daily Living; D055826:Afghan Campaign 2001-; D000673:Amputation, Traumatic / Q000534:rehabilitation*; D015897:Comorbidity; D012090:Cumulative Trauma Disorders / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009104:Multiple Trauma / Q000534:rehabilitation*; D017060:Patient Satisfaction; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D014728:Veterans; D047829:Vietnam Conflict; D014910:Wheelchairs / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult