VA paradigm shift in care of veterans with limb loss

Developing consensus on important factors associated with lower limb prosthetic prescription and use

“…Outcomes need to be meaningful to users in addition to service providers/ professionals. There is an ongoing and appropriate emphasis in the Veteran's Administration and CARF to promote clientcentered care [3,[25][26][27]. This study suggests that it is both feasible and essential to get a diversity of perspectives and that users can and should be included in these expert consensus panels and processes.…”

“…Consequently, it is important that the service user viewpoint is considered along with other viewpoints in identifying important factors. The inclusion of service providers and users in the expert panel in this study is in keeping with recent expert advisory panels for research studies where service providers, academics and users are included to guide the study, to inform recommendations and to maintain a focus on the realities of limb loss [3,25]. Sigeford [26] prioritizes the person centeredness of care and states that the person receiving care must drive the process and set the goals.…”

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs

“…Through the provision of quality rehabilitation and prosthetic limb care, the ASoC strives to minimize disability and enable the highest level of social, vocational, and recreational success for veterans with an amputation. [1][2][3] The policy and procedures for the ASoC have been detailed in prior VA Handbooks and in the ASoC Directive. 1 This article highlights the background, population served, and organizational structure of the ASoC by detailing the outcomes and accomplishments of this systems-based approach to longitudinal amputation care between 2009 and 2019.…”

“…1,2 Throughout its history, the VA has placed a high priority on the care that is provided to veterans with limb amputation. 1,3 Amputations have medical, physical, social, and psychological ramifications for the veteran and his or her family. Therefore, management of veterans with limb loss requires a comprehensive, coordinated, transdisciplinary program of services throughout the continuum of care.…”

Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lower-limb loss

“…Although the actual incidence of bilateral amputation has not been reported, it has been established that 30 to 50 percent of people who have an amputation related to diabetes will undergo amputation of the contralateral limb 3 to 5 yr after the primary amputation [2][3]. Moreover, with the increase in world conflict over the past decade with Operation Iraqi Freedom/Operation Enduring Freedom, coupled with medical advancements and improved emergency medical technician services domestically and abroad, the number of individuals surviving with traumatic bilateral lower-limb amputation (BLLA) has increased [4][5]. As of September 2010, of the 1,073 servicemembers (SMs) who have lost limbs, 261 (24%) have lost multiple limbs.…”