Microprocessor knee versus non-microprocessor knee for backup device in lower limb prostheses: A qualitative study
Abstract: Introduction: Current policy in the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC) is to provide individuals who require a prosthesis for a knee disarticulation (KD) or transfemoral (TF)-level amputation a microprocessor knee (MPK) unit for daily use and a non-microprocessor knee unit (N-MPK) as a backup prosthesis. Given the known functional differences between these two types of prosthetic knee units, the purpose of this study was to gain an understanding of user device preference and the impact of switching between the MPK and N-MPK. Methods: Four currently serving CAF members and two Veterans with unilateral TF or KD amputation participated in semi-structured interviews. Qualitative content analysis identified key themes reflecting their experiences using prostheses. Results: Seven major categories emerged that helped shape prosthesis preferences: functionality, physical aspects, mental aspects, activity, maintenance, safety, and health-related quality of life. The MPK was superior in all categories, resulting in considerably fewer falls and improved cognitive and physical performance. The four participants who had an N-MPK backup did not use this device and instead received a loaner MPK from their prosthetist when required. Discussion: For individuals who do not have ready access to their prosthetist to obtain a loaner knee unit, consideration should be given for a backup prosthesis with the same MPK unit as their daily-use prosthesis, as participants identify significant issues when trying to function with an N-MPK unit. Individuals with ready access to a loaner knee unit through their prosthetist may not require a backup prosthesis.
Abstract: We sought to quantify the impact of injury characteristics and setting on the development of mental health conditions, comparing combat to noncombat injury mechanisms. Due to advances in combat casualty care, military service-members are surviving traumatic injuries at substantial rates. The nature and setting of traumatic injury may influence the development of subsequent mental health disorders more than clinical injury characteristics. TRICARE claims data was used to identify servicemembers injured in combat between 2007 and 2011. Controls were servicemembers injured in a noncombat setting matched by age, sex, and injury severity. The rate of development, and time to diagnosis [in days (d)], of 3 common mental health conditions (post-traumatic stress disorder, depression, and anxiety) among combat-injured servicemembers were compared to controls. Risk factors for developing a new mental health condition after traumatic injury were evaluated using multivariable logistic regression that controlled for confounders. There were 3979 combat-injured servicemember and 3979 matched controls. The majority of combat injured servicemembers (n = 2524, 63%) were diagnosed with a new mental health condition during the course of follow-up, compared to 36% (n = 1415) of controls (P < 0.001). In the adjusted model, those with combat-related injury were significantly more likely to be diagnosed with a new mental health condition [odds ratio (OR): 3.18, [95% confidence interval (CI): 2.88–3.50]]. Junior (OR: 3.33, 95%CI: 2.66–4.17) and senior enlisted (OR: 2.56, 95%CI: 2.07–3.17) servicemem-bers were also at significantly greater risk. We found significantly higher rates of new mental health conditions among servicemembers injured in combat compared to service-members sustaining injuries in noncombat settings. This indicates that injury mechanism and environment are important drivers of mental health sequelae after trauma.