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Introduction: Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U.S. Military SMs treated in Military Treatment Facilities, who have sustained various levels of deployment-related UL amputation., Methods: The study sample was ascertained from the Expeditionary Medical Encounter Database housed at the Naval Health Research Center in San Diego, California. SMs with an immediate (within 24 hours of injury) deployment-related unilateral major UL amputation (partial hand and proximal), occurring between January 2001 and December 2014 were identified. SMs with concurrent major lower limb amputation (partial foot and proximal) were excluded. Frequency of OT outpatient visits and units of treatment received were quantified in 3-month increments during the first year after amputation and compared for individuals with above elbow (at or proximal to elbow joint) and below elbow (distal to the elbow joint including partial hand) amputation. This study was approved by the Naval Health Research Center Institutional Review Board., Results: A total of 29,878 encounters occurred during first year after amputation in 148 patients, who had sustained UL loss during the first year after amputation. Active treatments were included in 79.2% of all treatments, followed by manual therapy (13.7%) and modalities (13.5%). A higher number of OT encounters occurred in the above elbow amputation group-the first year of treatment with significantly higher mean number of treatments months 4 to12. A similar pattern in OT encounters was observed in the active therapy category with significantly higher mean number of treatments occurring in above elbow limb loss group in months 10 to 12., Conclusion: Findings of the current study suggest SMs with UL amputation utilize OT services often within the first year after injury and those who have sustained amputation proximal to the elbow received more therapy visits than their below elbow counterparts during months 4 to 12. Prosthetic training, therapeutic activities, and therapeutic exercise can be expected to be the highest used active interventions in the first year following UL amputation. Further research is needed to determine details on types and frequency of therapy utilization and recommended therapy strategies., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Military service members with limb loss have unrestricted access to physical therapy (PT) services. Identifying PT interventions used based on clinical rationale and patient needs/goals can provide insight towards developing best practice guidelines. The purpose of this study was to identify preferred PT practice patterns for military service members with lower limb loss., Materials and Methods: This was a retrospective cohort study and was approved by the Naval Health Research Center (NHRC) Institutional Review Board. Data for 495 service members with lower limb loss was analyzed. Frequency of PT visits and units of treatment received were quantified in 3-month increments during the first year after injury and compared for individuals with unilateral limb loss distal to the knee (DIST), unilateral limb loss proximal to the knee (PROX), and bilateral limb loss (BILAT)., Results: A total of 86,145 encounters occurred during the first year after injury. Active treatments were included in 94.0% of all treatments, followed by manual therapy (15.1%), patient education (11.5%) and modalities (2.4%). The highest number of encounters, consisting of active and manual therapy, was received by the DIST group within the first 3 months, while after the first 3 months, the BILAT group had higher encounters and received more active and manual therapy. Utilization of patient education was higher in the PROX and BILAT groups compared to the DIST group throughout the first year after injury., Conclusions: Service members with limb loss utilize PT services often within the first year after injury. Trends of PT practice are most likely influenced by comorbidities and healing time variance between levels of amputation., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Introduction: Young military Service Members with traumatic unilateral lower limb amputations may be at a high risk for developing knee osteoarthritis (OA). There is growing evidence for potential influence and predictive value of nonsystemic risk factors on development and progression of primary knee OA in older adults. Proposed factors include chronic knee pain, obesity, abnormal knee joint mechanics, muscle weakness, previous knee trauma, and altered physical activity level. However, there is limited information available regarding whether such nonsystemic risk factors could also be responsible for the increased risk of knee OA after traumatic, unilateral lower limb amputation in young military Service Members. The purpose of this narrative review is to compile and present evidence regarding prevalence of nonsystemic and potentially modifiable knee OA risk factors in Service Members with traumatic, unilateral lower limb amputation, and to identify potential strategies for intervention., Materials and Methods: A comprehensive literature search was performed in July 2015 using structured search terms related to nonsystemic risk factors for knee OA., Results: Current collective evidence does suggest an elevated prevalence of the nonsystemic knee OA risk factors in young military Service Members with unilateral lower limb amputation. In conclusion, the present state of the literature supports that young military Service Members with traumatic unilateral lower limb amputations may be at increased risk for developing knee OA compared to nonamputees. Military Service Members injured at a young age have a long life expectancy, and thus require comprehensive rehabilitation programs to prevent or delay progression of knee OA. Given the lack of strong evidence, further clinical research is needed to determine whether early identification and modification of nonsystemic risk factors for knee OA could optimize long-term function and quality of life in young Service Members after traumatic, unilateral, limb amputations., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)