Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study.
Fraje C E Watson, Angela E Kedgley, Susie Schofield and 5 others
PMID 38952004WHAT IT FOUND
At follow-up, lower limb loss alone did not produce clinically important upper limb disability compared with uninjured military personnel.
Major and partial upper limb loss produced higher disability than uninjured and lower limb loss groups.
Key findings
01Injured participants had higher upper limb disability scores than uninjured participants, but the difference did not meet the clinically important threshold.
02Participants with major or partial upper limb loss had higher upper limb disability than uninjured participants and participants with lower limb loss, and these differences met the clinically important threshold.
03Participants with lower limb loss had only a small, nonsignificant upper limb disability difference from uninjured participants that did not meet the clinically important threshold.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied only on a patient-reported upper limb disability questionnaire, so it does not measure physical performance, strength, range of motion, or objective prosthetic function. People with upper limb loss who also had lower limb loss were placed in upper limb groups for statistical robustness, so the separate effect of multiple limb loss cannot be measured. The lower limb loss group received upper limb-specific rehabilitation, so their upper limb function may reflect that care rather than the natural course after injury. The cohort was male, young, military, and highly rehabilitated, with few women and mostly blast injuries, so results may not apply to older civilian amputees or women. The major and partial upper limb loss groups were small, with 16 and 42 participants, so subgroup comparisons are limited. The DASH questionnaire may not reflect modern assistive technology such as smartphones and speech-to-text, which can change daily upper limb demands. Thirteen participants were excluded from analysis, including 11 with invalid DASH scores, and the analysed sample was 1132 of the 1145 cohort. Details of prosthesis use in people with partial upper limb loss were not captured. The paper lists several subgroup hypotheses and does not name a single primary endpoint, so the most important comparison is not fixed.
Declared interests
The funder is named ADVANCE. The paper states the funder played no role in design, conduct, or reporting. Publication types indicate non-U.S. government support.
The easy way to misread this
Do not conclude that lower limb loss causes clinically important upper limb disability at this follow-up. The lower limb loss group differed from uninjured participants by 0.83 points on a 0 to 100 scale, was not significant, and did not reach the 10.8 point minimum clinically important difference. The higher disability findings apply to major and partial upper limb loss, not to lower limb loss alone.