An VHA-funded study aims to develop a prosthetic ankle-foot system that allows female veterans to more easily change footwear with different heel heights.
Photograph courtesy of the Veterans Health Administration/GAO-21-60.
The United States Government Accountability Office (GAO) released a report to Congressional committees about the Department of Veterans Affairs (VA) Veterans Health Administration’s (VHA’s) prosthetic services for female veterans. House Report 115-188 included a provision for the GAO review.
The report examined trends in prosthetics provided by the VHA to female veterans; characteristics of the female veteran population with limb loss and how the VHA provides prosthetic services to these veterans through its Amputation System of Care; and the VHA’s research efforts and the challenges that exist in studying prosthetics for female veterans with limb loss.
The VHA’s Prosthetic and Sensory Aids Service (PSAS) provides prosthetics to veterans who have experienced the loss or permanent impairment of a body part or function. The PSAS definition of prosthetics includes medical devices and equipment ranging from artificial limbs and surgical implants to eyeglasses and hearing aid batteries. PSAS refers to prosthetics it provides to meet the health needs of female veterans, such as those related to breast cancer rehabilitation, pre- and post-pregnancy care, and military sexual trauma, as women’s health prosthetics.
The report said that in fiscal years 2015 to 2019, the proportion of prosthetic devices provided to female veterans grew from 6.8 percent to 7.9 percent and accounted for about $889.1 million of the $15.4 billion total cost of prosthetics. The VHA provided prosthetic services to a small but growing female veteran amputee population (almost 3 percent of veterans with amputations in fiscal year 2019), who were generally younger than male veterans with amputations.
The VHA established an individualized patient care approach in its Amputation System of Care that seeks to address the prosthetic needs of each veteran, including accounting for gender-specific factors. VHA officials said that using a standardized, multidisciplinary approach across VA medical facilities also helps them incorporate the concerns and preferences of female veterans. For example, veterans are provided care by a team that includes a physician, therapist, prosthetist, and other providers as needed.
Women are generally studied less than their male counterparts in prosthetic and amputee rehabilitation research. The VHA designated prosthetics for female veterans a national research priority in 2017, and has funded eight related studies as of May 2020: four pertain to lower-limb amputation, three pertain to upper-limb amputation, and one pertains to wheelchairs. One of the studies aims to develop a prosthetic ankle-foot system that allows female veterans to more easily change footwear with different heel heights.
VHA officials noted the importance of this research priority and the ongoing challenge of recruiting study participants due to the small female veteran population. VHA researchers said they employ various tactics to address this challenge, such as using multisite studies and recruiting participants from the non-veteran population.
To complete the report, the GAO analyzed VHA documents, as well as data from fiscal years 2015 to 2019 on prosthetics and veterans with amputations, and interviewed agency officials from the VHA and officials and female veteran amputees at two VA medical facilities selected for expertise in amputation care and prosthetics research activities. In addition, GAO interviewed VHA researchers conducting studies on prosthetics for female veterans.
To read the report, visit “Veterans Health Care: Agency Efforts to Provide and Study Prosthetics for Small but Growing Female Veteran Population” on the GAO website.
