Fraje C E Watson, Angela E Kedgley, Susie Schofield, Fearghal P Behan, Christopher J Boos, Nicola T Fear, Alexander N Bennett, Anthony M J Bull
{"title":"伤后 8 年上下肢缺失者的上肢功能:武装部队创伤结果研究(ADVANCE)队列研究》。","authors":"Fraje C E Watson, Angela E Kedgley, Susie Schofield, Fearghal P Behan, Christopher J Boos, Nicola T Fear, Alexander N Bennett, Anthony M J Bull","doi":"10.1093/ptj/pzae082","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.</p><p><strong>Methods: </strong>A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.</p><p><strong>Results: </strong>DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.</p><p><strong>Conclusion: </strong>People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.</p><p><strong>Impact: </strong>For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491512/pdf/","citationCount":"0","resultStr":"{\"title\":\"Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study.\",\"authors\":\"Fraje C E Watson, Angela E Kedgley, Susie Schofield, Fearghal P Behan, Christopher J Boos, Nicola T Fear, Alexander N Bennett, Anthony M J Bull\",\"doi\":\"10.1093/ptj/pzae082\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.</p><p><strong>Methods: </strong>A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.</p><p><strong>Results: </strong>DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.</p><p><strong>Conclusion: </strong>People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.</p><p><strong>Impact: </strong>For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. 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引用次数: 0
摘要
目的:文献中对UL截肢者的上肢(UL)残疾情况有大量报道,但对下肢截肢者的报道较少。本研究旨在比较受伤(重大创伤)和未受伤的英国军人的上肢残疾情况,尤其关注上肢和下肢截肢者:在阿富汗战争中服役的英国受伤(579 人)和未受伤(566 人)军人的志愿者样本在年龄、性别、服役时间、军衔、兵团、角色和部署时间上进行了频率匹配,并被招募到武装部队创伤康复结果(ADVANCE)纵向队列研究中。参与者在受伤后 8 年完成了手臂、肩部和手部残疾(DASH)问卷调查,得分从 0(无残疾)到 100(最大残疾)不等。Mann-Whitney U 和 Kruskal Wallis 检验用于比较不同组间的 DASH 分数。采用序数模型评估受伤和截肢对 DASH 评分的影响:结果:受伤组的 DASH 得分高于未受伤组(3.33 vs 0.00),下肢缺失者的 DASH 得分高于未受伤组(0.83 vs 0.00),但差异无统计学意义。在调整后的序数模型中,与未受伤组相比,下肢缺失者 DASH 得分较高的几率为 1.70(95% CI = 1.18-2.47)倍。主要UL缺失者和部分UL缺失者的DASH评分差异不大(15.42 vs 12.92)。与未受伤组相比,UL缺失者DASH评分较高的几率是未受伤组的8.30倍(95% CI = 5.07-13.60):结论:与未受伤的人群相比,下肢缺失者在伤后8年出现更多UL残疾的几率更高。主要和部分UL缺失者的UL残疾程度相似。ADVANCE研究将在未来20年内继续跟踪这一人群:影响:首次发现下肢长期缺失者的上肢残疾可能性更大,这可能是日常生物力学代偿(如负重、平衡和发电)造成的。这一人群可能会从预防性上肢康复、力量和技术中受益。
Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study.
Objective: Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.
Methods: A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.
Results: DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.
Conclusion: People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.
Impact: For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.
期刊介绍:
Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.