A team of researchers conducted a study to predict prosthetic prescription after major lower-limb amputation. They described prosthetic limb prescription in the first year following lower-limb amputation and examined the relationship between amputation level, geographic region, and prosthetic prescription. Data was analyzed from the U.S. Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database (NPPD) for 9,994 veterans who underwent lower-limb amputation at a VA hospital between 2005 and 2010. Analyses showed that amputation level was associated with prosthetic prescription. They found that African American race, longer length of hospital stays, older age, congestive heart failure, paralysis, other neurological disease, renal failure, admission from a nursing facility, receiving care in the South, and reamputation were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputations were most likely to be prescribed a prosthesis and people with transfemoral amputations were least likely.
The study authors said additional research is needed to identify the factors associated with reduced likelihood of prosthetic prescription in the African American population and the geographic variation in practice pattern.
Those patients who did receive prostheses in the South received them, on average, 14 to 32 days later than those from other regions. “This suggests that the VA medical centers in this region may not have sufficient capacity to meet the needs of their patients in a timely manner,” the authors wrote. “Almost twice the number of VA patients in our sample were from the South as compared with any other region. Thus, we expect that the burden of costs for prosthetic care in South VA medical centers would be higher than in other regions, and it is possible that the South might be attempting to manage costs by being more conservative in their prosthetic prescription practices. Similar patterns of prosthetic prescription may exist outside of the VA system of care, and future research should examine whether this finding can be generalized to prosthetic prescription patterns in other settings.”
The authors acknowledged that their study has limitations. First, these results are not generalizable to veterans with amputations whose surgeries were outside the VA who then later received prosthetic services at the VA. Second, there was no method of validating the accuracy of the NPPD data used; however, there is no reason to expect that there would be any systematic bias in the data quality by level of amputation or by geographic region. The authors also suggest there is room for improvement in service delivery.
The study was published in volume 52, number 6 of the
Journal of Rehabilitation Research & Development.
