{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:16:05Z","timestamp":1793301365556,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T00:00:00Z","timestamp":1572220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U.S. Military SMs treated in Military Treatment Facilities, who have sustained various levels of deployment-related UL amputation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study sample was ascertained from the Expeditionary Medical Encounter Database housed at the Naval Health Research Center in San Diego, California. SMs with an immediate (within 24\u00a0hours of injury) deployment-related unilateral major UL amputation (partial hand and proximal), occurring between January 2001 and December 2014 were identified. SMs with concurrent major lower limb amputation (partial foot and proximal) were excluded. Frequency of OT outpatient visits and units of treatment received were quantified in 3-month increments during the first year after amputation and compared for individuals with above elbow (at or proximal to elbow joint) and below elbow (distal to the elbow joint including partial hand) amputation. This study was approved by the Naval Health Research Center Institutional Review Board.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 29,878 encounters occurred during first year after amputation in 148 patients, who had sustained UL loss during the first year after amputation. Active treatments were included in 79.2% of all treatments, followed by manual therapy (13.7%) and modalities (13.5%). A higher number of OT encounters occurred in the above elbow amputation group\u2014the first year of treatment with significantly higher mean number of treatments months 4 to12. A similar pattern in OT encounters was observed in the active therapy category with significantly higher mean number of treatments occurring in above elbow limb loss group in months 10 to 12.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Findings of the current study suggest SMs with UL amputation utilize OT services often within the first year after injury and those who have sustained amputation proximal to the elbow received more therapy visits than their below elbow counterparts during months 4 to 12. Prosthetic training, therapeutic activities, and therapeutic exercise can be expected to be the highest used active interventions in the first year following UL amputation. Further research is needed to determine details on types and frequency of therapy utilization and recommended therapy strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usz341","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T18:46:15Z","timestamp":1572461175000},"page":"444-450","source":"Crossref","is-referenced-by-count":8,"title":["Occupational Therapy Practice Patterns for Military Service Members With Upper Limb Amputation"],"prefix":"10.1093","volume":"185","author":[{"given":"Jill M","family":"Cancio","sequence":"first","affiliation":[{"name":"Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234"},{"name":"Extremity Trauma and Amputation Center of Excellence, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Orr","sequence":"first","affiliation":[{"name":"Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Eskridge","sequence":"first","affiliation":[{"name":"Leidos, San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaeley","family":"Shannon","sequence":"first","affiliation":[{"name":"Axiom Resource Management, Inc., San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittney","family":"Mazzone","sequence":"first","affiliation":[{"name":"Extremity Trauma and Amputation Center of Excellence, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234"},{"name":"Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Farrokhi","sequence":"first","affiliation":[{"name":"Extremity Trauma and Amputation Center of Excellence, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234"},{"name":"Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,28]]},"reference":[{"key":"2020060306200302800_ref1","first-page":"493","volume-title":"Care of the Combat Amputee","author":"Smurr","year":"2009"},{"key":"2020060306200302800_ref2","first-page":"33","volume-title":"Rehabilitation of the Injured Combatant","author":"Dillingham","year":"1998"},{"issue":"7","key":"2020060306200302800_ref3","first-page":"10","article-title":"Major deployment-related amputations of lower and upper limbs, active and reserve components, U.S. armed forces, 2001-2017","volume":"25","author":"Farrokhi","year":"2018","journal-title":"Med Surv Monthly Rep"},{"issue":"3","key":"2020060306200302800_ref4","doi-asserted-by":"crossref","first-page":"147","DOI":"10.7205\/MILMED-D-09-00120","article-title":"Midterm health and personnel outcomes of recent combat amputees","volume":"175","author":"Melcer","year":"2010","journal-title":"Mil Med"},{"issue":"6 Suppl 5","key":"2020060306200302800_ref5","doi-asserted-by":"crossref","first-page":"S438","DOI":"10.1097\/TA.0b013e318275469c","article-title":"Ten years at war: comprehensive analysis of amputation trends","volume":"73","author":"Krueger","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2020060306200302800_ref6","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/BOT.0b013e31815b35aa","article-title":"Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq","volume":"22","author":"Stansbury","year":"2008","journal-title":"J Orthop Trauma"},{"issue":"6","key":"2020060306200302800_ref7","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1097\/TA.0b013e3181bb9a6c","article-title":"Return to duty rate of amputee soldiers in the current conflicts in Afghanistan and Iraq","volume":"68","author":"Stinner","year":"2010","journal-title":"J Trauma"},{"issue":"Suppl 1","key":"2020060306200302800_ref8","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.5435\/00124635-201102001-00002","article-title":"Battlefield orthopaedic injuries cause the majority of long-term disabilities","volume":"19","author":"Cross","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"issue":"10","key":"2020060306200302800_ref9","doi-asserted-by":"crossref","first-page":"S183","DOI":"10.5435\/00124635-200600001-00040","article-title":"The United States Armed Forces Amputee Patient Care Program","volume":"14","author":"Gajewski","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"issue":"10 Spec","key":"2020060306200302800_ref10","doi-asserted-by":"crossref","first-page":"S188","DOI":"10.5435\/00124635-200600001-00041","article-title":"Amputation is not isolated: an overview of the US Army Amputee Patient Care Program and associated amputee injuries","volume":"14","author":"Potter","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"issue":"2","key":"2020060306200302800_ref11","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1197\/j.jht.2007.09.006","article-title":"Managing the upper extremity amputee: a protocol for success","volume":"21","author":"Smurr","year":"2008","journal-title":"J Hand Ther"},{"issue":"3","key":"2020060306200302800_ref12","first-page":"39","article-title":"Center for the Intrepid: providing patients POWER","volume":"3","author":"Amorelli","year":"2016","journal-title":"US Army Med Dep J"},{"issue":"9","key":"2020060306200302800_ref13","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.jmpt.2009.10.010","article-title":"Integrated musculoskeletal rehabilitation care at a comprehensive cobat and complex casualty care program","volume":"32","author":"Goldbert","year":"2009","journal-title":"J Manipulative Physiol Ther"},{"issue":"3","key":"2020060306200302800_ref14","doi-asserted-by":"crossref","first-page":"209","DOI":"10.7205\/MILMED.171.3.209","article-title":"Process of care for battle casualties at Walter reed Army Medical Center: Part IV. Occupational therapy service","volume":"171","author":"Howard","year":"2006","journal-title":"Milit Med"},{"issue":"6","key":"2020060306200302800_ref15","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.apmr.2007.09.058","article-title":"Effect of training on upper-extremity prosthetic performance and motor learning: a single-case study","volume":"89","author":"Dromerick","year":"2008","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"2020060306200302800_ref16","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1682\/JRRD.2008.10.0138","article-title":"Occupational therapy protocol for amputees with targeted muscle reinnervation","volume":"46","author":"Stubblefield","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"2020060306200302800_ref17","volume-title":"Rehabilitation of the Hand and Upper Extremity","author":"Yancosek","year":"2011","edition":"6th"},{"issue":"1","key":"2020060306200302800_ref18","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.pmr.2018.08.011","article-title":"Upper extremity amputation and prosthetics care across the active duty military and veteran populations","volume":"30","author":"Cancio","year":"2019","journal-title":"Phys Med Rehabil Clin N Am."},{"key":"2020060306200302800_ref19","volume-title":"VA\/DoD Clinical Practice Guidelines for the Management of Upper Extremity Amputation Rehabilitation","author":"Group MoUEARW","year":"2014"},{"issue":"8","key":"2020060306200302800_ref20","doi-asserted-by":"crossref","first-page":"691","DOI":"10.7205\/MILMED.171.8.691","article-title":"The Navy-Marine Corps combat trauma registry","volume":"171","author":"Galarneau","year":"2006","journal-title":"Mil Med"},{"issue":"3","key":"2020060306200302800_ref21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J Trauma"},{"issue":"12","key":"2020060306200302800_ref22","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.injury.2006.07.009","article-title":"AIS 2005: a contemporary injury scale","volume":"37","author":"Gennarelli","year":"2006","journal-title":"Injury"},{"issue":"6","key":"2020060306200302800_ref23","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.injury.2014.02.009","article-title":"Characterisation and outcomes of upper extremity amputations","volume":"45","author":"Tennent","year":"2014","journal-title":"Injury"},{"issue":"12","key":"2020060306200302800_ref24","doi-asserted-by":"crossref","first-page":"751","DOI":"10.5435\/JAAOS-D-14-00302","article-title":"Functional and clinical outcomes of upper extremity amputation","volume":"23","author":"Fitzgibbons","year":"2015","journal-title":"J Am Acad Orthop Surg"},{"issue":"3","key":"2020060306200302800_ref25","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.apmr.2007.11.005","article-title":"Estimating the prevalence of limb loss in the United States: 2005 to 2050","volume":"89","author":"Ziegler-Graham","year":"2008","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"2020060306200302800_ref26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1682\/JRRD.2009.03.0027","article-title":"Unilateral upper-limb loss: satisfaction and prosthetic-device use in veterans and service members from Vietnam and OIF\/OEF conflicts","volume":"47","author":"McFarland","year":"2010","journal-title":"J Rehabil Res Dev"},{"key":"2020060306200302800_ref27","volume-title":"Physical Therapy Practice Patterns for Military Service Members with Lower Extremity Amputations Paper Presented at: American Physical Therapy Association Combined Sections Meetings","author":"Mazzone","year":"2017"},{"issue":"9","key":"2020060306200302800_ref28","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.apmr.2005.03.005","article-title":"Use and perceived need of physical therapy following severe lower-extremity trauma","volume":"86","author":"Castillo","year":"2005","journal-title":"Arch Phys Med Rehabil"},{"issue":"Suppl 1","key":"2020060306200302800_ref29","first-page":"S1","article-title":"Occupational therapy practice framework: domain and process","volume":"68","author":"Association AOT","year":"2014","journal-title":"Am J Occup Ther"},{"issue":"7","key":"2020060306200302800_ref30","doi-asserted-by":"crossref","first-page":"593","DOI":"10.2340\/16501977-0985","article-title":"Health services utilization in adult acquired major upper-limb amputees: a population-based survey","volume":"44","author":"Ostlie","year":"2012","journal-title":"J Rehabil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/3-4\/444\/33339844\/usz341.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/3-4\/444\/33339844\/usz341.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T10:20:18Z","timestamp":1591179618000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/185\/3-4\/444\/5607593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,28]]},"references-count":30,"journal-issue":{"issue":"3-4","published-online":{"date-parts":[[2019,10,28]]},"published-print":{"date-parts":[[2020,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usz341","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2019,10,28]]}}}