Racial disparities in prosthesis use, satisfaction, and physical function in upper limb amputation and the impact of Veteran status

Abstract: Background: Prior research found that Black veterans with upper limb amputation (ULA) reported greater disability and need for assistance compared to White veterans. The extent to which racial disparities in outcomes exist outside of the Department of Veterans Affairs has not been explored. Objective: To examine racial disparities in physical function and prosthesis satisfaction among individuals with ULA and assess the potential moderating role of veteran status. Design: Cross-sectional survey. Setting: Community-dwelling participants. Participants: U.S. veterans and civilians with ULA. Interventions: Not applicable. Main outcome measures: Physical function measures included Patient-Reported Outcomes Measurement Information System-Upper Extremity Amputation-specific (PROMIS-UE AMP), and Upper Extremity Functional Scale for Prosthesis Users (UEFS-P) for one-handed and two-handed tasks. Prosthesis satisfaction measures included the modified Client Satisfaction with Device (CSD) Comfort, Appearance, and Utility scales, the CSD-8, and the Trinity Amputation and Prosthesis Experience Satisfaction (TAPES) scale. Results: Of 713 participants, 79% were male, with mean age of 61.3 years. The racial composition was 83.6% White, 9.1% Black, and 7.3% other, with 75.4% identifying as veterans. Multivariable linear regression found that Black participants (compared to White) had lower PROMIS 13-UE AMP (β: -5.1, 95% CI: -7.7 to -2.5) and UEFS-P Two-Handed Task Scale (β: -4.0, 95% CI: -7.3 to -2.1) scores. Satisfaction scores were lower for Black participants as measured by modified CSD Comfort (β: -3.9, 95% CI: -7.2 to -0.6), Appearance (β: -4.4, 95% CI: -7.5 to -1.2), Utility (β: -3.9, 95% CI: -7.2 to -0.6), and CSD-8 (β: -3.9, 95% CI: -7.2 to -0.6) scales. Veteran status moderated the impact of Black race on the UEFS-P Two-Handed Task Scale and the TAPES. Conclusions: Black individuals with ULA had worse physical function and prosthesis satisfaction than White individuals. Although veteran status moderated these disparities, the reasons for these disparities remain unclear. Further research is essential to understand the causes of these disparities.

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