{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:33:01Z","timestamp":1787884381296,"version":"build-2784847793"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100027399","name":"ADVANCE","doi-asserted-by":"publisher","award":["ADV-H4H-01"],"award-info":[{"award-number":["ADV-H4H-01"]}],"id":[{"id":"10.13039\/100027399","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100027399","name":"ADVANCE","doi-asserted-by":"publisher","award":["ADV-IC-KCL-01"],"award-info":[{"award-number":["ADV-IC-KCL-01"]}],"id":[{"id":"10.13039\/100027399","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100027399","name":"ADVANCE","doi-asserted-by":"publisher","award":["ADV-IC-Core-01"],"award-info":[{"award-number":["ADV-IC-Core-01"]}],"id":[{"id":"10.13039\/100027399","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100027399","name":"ADVANCE","doi-asserted-by":"publisher","award":["ADV-ADMR-03"],"award-info":[{"award-number":["ADV-ADMR-03"]}],"id":[{"id":"10.13039\/100027399","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A volunteer sample of injured (n\u00a0=\u2009579) and uninjured (n\u00a0=\u2009566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8\u00a0years postinjury. Mann\u2013Whitney U and Kruskal\u2013Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI\u2009=\u20091.18\u20132.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI\u2009=\u20095.07\u201313.60) times higher for people with UL loss compared to the Uninjured group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8\u00a0years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20\u00a0years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzae082","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T13:12:08Z","timestamp":1719925928000},"source":"Crossref","is-referenced-by-count":10,"title":["Upper Limb Function in People With Upper and Lower Limb Loss 8\u00a0Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study"],"prefix":"10.1093","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3716-9267","authenticated-orcid":false,"given":"Fraje C E","family":"Watson","sequence":"first","affiliation":[{"name":"Department of Bioengineering, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela E","family":"Kedgley","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Schofield","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute , Faculty of Medicine, , London ,","place":["UK"]},{"name":"Imperial College London , Faculty of Medicine, , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fearghal P","family":"Behan","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Imperial College London , London ,","place":["UK"]},{"name":"Discipline of Physiotherapy , School of Medicine, , Dublin ,","place":["Ireland"]},{"name":"Trinity College Dublin , School of Medicine, , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J","family":"Boos","sequence":"additional","affiliation":[{"name":"Faculty of Health and Social Sciences, Bournemouth University , Poole ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola T","family":"Fear","sequence":"additional","affiliation":[{"name":"King\u2019s Centre for Military Research, King\u2019s College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander N","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Imperial College London , London ,","place":["UK"]},{"name":"Academic Department of Military Rehabilitation, Defence Military Rehabilitation Centre , Loughborough ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M J","family":"Bull","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Imperial College London , London 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