0 Item(s)
Upper-Limb Prostheses: Perspectives Involving the Veteran Population
State of the Science Conference Findings
Keyword(s)
upper-limb prosthetics, veterans, practice guideline, Amputation System of Care
Evidence-based practice has been described as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Clinical practice guidelines are statements of recommended practice based on a systematic review of the best available evidence and expert opinion. A systematic review evaluates research studies in a particular area and produces a summary of overall results. Recent publications to inform evidence-based prescription of upper-limb prostheses, including a 2014 systematic review of the differences in myoelectric and body-powered systems by Carey et al. showing a lack of empirical evidence. This lack of evidence makes it challenging to determine the most effective and appropriate prosthetic interventions for individuals with upper-limb amputations, including those who are veterans. There is, however, a substantial amount of practice-based evidence (expert opinion) available to help guide clinical care. In 2008, in response to the current and future need to advance the clinical care for veterans with amputation, the Department of Veterans Affairs (VA) rolled out its Amputation System of Care (ASoC) model. Its mission is to incorporate the latest practices in medical rehabilitation, including therapy services and prosthetic technology, to enhance the quality and consistency of amputation care for US veterans. Furthermore, the VA and Department of Defense (DoD) have collaborated to address the need for clinical guidance specifically regarding upper-limb amputation and rehabilitation with the 2014 publication of the “VA/DoD Clinical Practice Guideline for the Management of Upper Extremity Amputation Rehabilitation” (UEAR-CPG). The purpose of this paper is to introduce and describe the ASoC as well as the UEAR-CPG and offer perspectives of the authors in their respective roles as clinicians in each, the VA and the DoD environments. (J Prosthet Orthot. 2017;29:P51–P56)
Author(s)
Christopher Fantini, MSPT, CP, BOCO; Kathleen E. Yancosek, PhD, OTR/L, CHT
Description
Evidence-based practice has been described as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.1 Clinical practice guidelines are statements of recommended practice based on a systematic review of the best available evidence and expert opinion. A systematic review evaluates research studies in a particular area and produces a summary of overall results. Recent publications to inform evidence-based prescription of upper-limb prostheses, including a 2014 systematic review of the differences in myoelectric and body-powered systems by Carey et al. showing a lack of empirical evidence.2,3 This lack of evidence makes it challenging to determine the most effective and appropriate prosthetic interventions for individuals with upper-limb amputations, including those who are veterans. There is, however, a substantial amount of practice-based evidence (expert opinion) available to help guide clinical care.