Understanding Implications of Residual limb length, Strength and Range of motion impairments of Veterans with Upper Limb Amputation.

Objective To describe and quantify the relationship between limb impairment variables to key functional outcomes. Design Observational study of 107 participants with unilateral above/at elbow (AE) or below elbow/wrist (BE) amputation. Demographics, prosthesis characteristics, residual limb length (RLL), and prevalence of passive range-of-motion (PROM) restrictions, and strength impairments were described. Correlations between impairment variables were estimated. Linear regressions examined associations between impairment variables and activity performance, HRQoL, disability and prosthesis satisfaction. Results Prevalence of short/very short BE and AE residua was 25.7%, and 12.5% respectively. Shorter BE RLL was correlated with elbow flexion weakness (r = 0.30) and PROM (r-0.25). Shoulder PROM restrictions were correlated with shoulder (r: 0.27-0.51) and elbow weakness (r: 0.25-0.46). In regressions, Activity performance was worse for those with shoulder flexion PROM restrictions (B = -5.0, p = 0.03) and better for those with flexion restrictions (B = 3.3, p = 0.04) compared to normal PROM. Prosthetic satisfaction was lower for those with limited elbow PROM. Conclusions Short BE RLL was correlated with impairment of elbow flexion strength and PROM. PROM restrictions were most prevalent at the shoulder and were strongly correlated with weakness in the same planes of motion. Few significant associations were found between impairment variables and outcomes.