Prosthesis nonuse and discontinuation in United States veterans with major limb amputation: Results of a national survey.

BACKGROUND: Prosthesis use in persons with amputation can improve mobility and functional independence. Better understanding of the reasons for and outcomes associated with prosthesis nonuse is important to optimize function and long-term health in persons with amputation. OBJECTIVES: Study objectives were to describe the rate, reasons for, and factors associated with never using or discontinuing prosthesis use in United States (US) veterans with amputation. STUDY DESIGN: Cross-sectional study design. METHODS: The study used an online survey to assess prosthesis use and satisfaction in veterans with upper-limb and lower-limb amputation. Survey participation invitations were distributed by email, text message, and mail to 46,613 potential participants. RESULTS: The survey response rate was 11.4%. After exclusions, an analytic sample of 3,959 respondents with a major limb amputation was identified. The sample was 96.4% male; 78.3% White, with mean age of 66.9; and mean of 18.2 years since amputation. The rate of never using a prosthesis was 8.2%, and the rate of prosthesis discontinuation was 10.5%. Functionality (62.0%), undesirable prosthesis characteristics (56.9%), and comfort (53.4%) were the most common reasons for discontinuation. After controlling for the amputation subgroup, the odds of prosthesis discontinuation were higher for those with unilateral upper-limb amputation, female gender, White race (compared with Black race), diabetes, above-knee amputation, and lower prosthesis satisfaction. Prosthesis satisfaction and quality of life were highest for current prosthesis users. CONCLUSIONS: This study adds new understanding regarding the rate and reasons for prosthesis nonuse in veterans and highlights the important relationship between prosthesis discontinuation and prosthesis satisfaction, quality of life, and satisfaction with life.

Management of Upper Limb Amputation Rehabilitation: Synopsis of the 2022 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline for Acquired Amputation.

ABSTRACT: Upper limb amputation can result in significant functional impairment necessitating a comprehensive rehabilitation approach throughout the continuum of care. In 2022, the Departments of Veteran Affairs and Defense completed an updated clinical practice guideline for the management of upper limb amputation rehabilitation. This practice guideline was developed by a workgroup of subject-matter experts from a variety of disciplines. Twelve key questions were developed by the workgroup using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) format to establish the scope of the literature review. Eighteen recommendations were developed through extensive review of the available literature and use of the Grading of Recommendations, Assessment, Development and Evaluation criteria. The strength of each recommendation was determined based on the quality of the research evidence and the additional domains of the Grading of Recommendations, Assessment, Development and Evaluation criteria. Of the 18 recommendations, 4 were found to have sufficient evidence to suggest for use of a particular rehabilitation management strategy. Thus, the 2022 Department of Veteran Affairs and Department of Defense clinical practice guideline provides updated, evidence-based information on the care and rehabilitation of persons with upper limb amputation. However, a significant lack of high-quality evidence in upper limb amputation rehabilitation limited evidence-based clinical guidance to assist healthcare providers in managing this population.

The First FDA Approved Early Feasibility Study of a Novel Percutaneous Bone Anchored Prosthesis for Transfemoral Amputees: A Prospective 1-year Follow-up Cohort Study.

OBJECTIVE: Evaluate the safety and efficacy of a novel press-fit bone-anchored prosthesis in an FDA approved study. DESIGN: Single-center, prospective 1-year follow-up cohort study of a percutaneous bone anchored prosthesis. SETTING: Veterans Health Administration Hospital. PARTICIPANTS: Ten male Veterans with unilateral transfemoral amputation that occurred at least 6 months prior to enrollment and was not the result of dysvascular disease (N=10). INTERVENTIONS: All participants received the novel press-fit Percutaneous Osseointegrated Prosthesis (POP) and a minimum of 10 days supervised rehabilitation therapy. OUTCOME MEASURES: Adverse events and radiographs were collected to assess device safety. Temporal assessments of bone density, stomal skin, prosthetic don/doff, functional ambulation, and patient-reported outcome compared our POP to a socket suspension system. RESULTS: Ten male participants mean age 48.8±12.1 years (range, 32-68 y) with mean time since amputation of 9.4± years (range 1-18 y) completed a two-staged implantation protocol and progressed to ambulation with an assistive device by post-operative day 14. Eight of 10 completed all study procedures. One implant loosened at 5 weeks, requiring removal. A second was removed after periprosthetic fracture from a non-device-related fall at 28 weeks. One patient required oral antibiotics for superficial infection. There were significant (P<.05) increases in bone density in the lumbar spine and adjacent to the distal porous coating with no radiographic evidence of bone resorption. Compared to the socket system, the use of POP significantly (P<.05) reduced prosthetic don and doff times and patient-reported prosthetic problem scores. Significant improvements (P<.05) in mean mobility, global health, and walking test scores were also observed. CONCLUSIONS: Improvements in bone density, function, and patient reported outcomes were observed with the POP device when compared to a socket suspension system. This Early Feasibility Study established initial safety and effectiveness of the POP device, supporting expanded investigation as an alternative to socket prostheses.

Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study.

PURPOSE: To present population data on standardized measures of dexterity, activity performance, disability, health-related quality of life (HRQoL) and community integration for persons with upper limb amputation (ULA), compare outcomes to normative values, and examine differences by prosthesis type and laterality (unilateral vs. bilateral amputation). MATERIALS AND METHODS: Multi-site, cross-sectional design, with in-person evaluations, functional performance, and self-report measures. Descriptive and comparative analyses were performed by amputation level and prosthesis type, data were compared for unilateral and bilateral amputation. RESULTS: One hundred and twenty-seven individuals participated; mean age 57 years, 59% percent body-powered prostheses users. All measures of dexterity differed (p < 0.05) by amputation level and by laterality. All measures of activity differed by amputation level with the best scores in transradial (TR) amputation groups. Comparisons of body-powered users with TR amputation found that dexterity was better for those with bilateral compared to unilateral amputation. CONCLUSIONS: Dexterity is markedly impaired in persons with ULA. Individuals with more proximal ULA levels are most impacted. HRQoL and community participation are less impacted and more equivalent to unimpaired persons. Further research is needed to examine differences by terminal device type and determine how best to match persons with ULA to the optimal prosthesis type and componentry, based on individual characteristics.Implications for RehabilitationThis study provides population-based, comparative data on dexterity, activity performance, disability, quality of life, and independence in upper limb prosthesis users.The study provides preliminary analyses comparing the effectiveness of body-powered devices, myoelectric devices with single degree of freedom and multi-degree of freedom terminal devices.The data presented in this study can be used to benchmark outcomes in patients who are upper limb prosthesis users.The data will also be useful to inform comparative evaluations of existing and emerging prosthetic technology.

Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans With Upper Limb Amputation.

OBJECTIVE: The aim of the study was to describe and quantify the relationship between limb impairment variables to key functional outcomes. DESIGN: This was an observational study of 107 participants with unilateral above/at-elbow or below-elbow/wrist amputation. Demographics, prosthesis characteristics, residual limb length, and prevalence of passive range-of-motion restrictions, and strength impairments were described. Correlations between impairment variables were estimated. Linear regressions examined associations between impairment variables and activity performance, health-related quality of life, disability, and prosthesis satisfaction. RESULTS: Prevalence of short/very short below- and above-elbow residua was 25.7% and 12.5%, respectively. Shorter below-elbow/wrist residual limb length was correlated with elbow flexion weakness (r = 0.30) and prevalence of passive range of motion (r = 0.25). Shoulder prevalence of passive range-of-motion 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 prevalence of passive range-of-motion restrictions (B = -5.0, P = 0.03) and better for those with flexion restrictions (B = 3.3, P = 0.04) compared with normal prevalence of passive range of motion. Prosthetic satisfaction was lower for those with limited elbow prevalence of passive range of motion. CONCLUSIONS: Short below-elbow residual limb length was correlated with impairment of elbow flexion strength and prevalence of passive range of motion. Prevalence of passive range-of-motion 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.

Frequency, severity, and implications of shoulder pain in people with major upper limb amputation who use prostheses: Results of a National Study.

BACKGROUND: People with upper limb amputation are potentially at increased risk of shoulder pain because they often perform compensatory movements to operate their prostheses and rely more heavily on their nonamputated limb for everyday activities. OBJECTIVE: To describe the frequency, severity, associated factors, and implications of shoulder pain in people with unilateral major upper limb amputation who use prostheses. DESIGN: Cross-sectional, observational design. SETTING: National recruitment of people living in the community. PARTICIPANTS: U.S. veterans and civilians (N = 107) with unilateral major upper limb amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Shoulder pain (any, ipsilateral and contralateral to amputation), activity performance (Activities Measure for Upper Limb Amputation), health-related quality of life (Veterans RAND 12-Item Health Survey mental component summary [MCS] and physical component summary [PCS]), and disability (Quick Version of the Disabilities of the Arm, Shoulder and Hand Score [QuickDASH]). RESULTS: All participants completed a comprehensive in-person assessment. Participants were 97% male with a mean age of 57.1 years and a mean time since amputation of 23.4 years. The prevalence of any shoulder pain was 30% (15% ipsilateral, 25% contralateral, 10% bilateral). Shoulder pain intensity (0 to 10 scale) was moderate for both ipsilateral (mean 4.9, SD 2.0) and contralateral (mean 4.2, SD 2.0) pain. No significant difference in shoulder pain frequency was observed by amputation level. The prevalence of any shoulder pain was greater in those using a body-powered prosthesis (38% compared to 18% in externally powered users). Each additional year since amputation was associated with an increased likelihood of having contralateral shoulder pain (odds ratio: 1.05, confidence interval: 1.01, 1.10). In linear regression models, those with contralateral shoulder pain had worse PCS (ß = -7.07, p = .008) and worse QuickDASH (ß = 18.25, p < .001) scores. CONCLUSIONS: In our sample of predominantly male veterans with major upper limb amputation, shoulder pain was a common condition associated with functional and quality of life implications. Among prosthesis users, the shoulder contralateral to the amputation was at greatest risk, with risk increasing with every year since amputation.

Upper limb prosthesis users: A longitudinal cohort study.

BACKGROUND: No previous studies have followed prosthesis users with upper limb loss or limb deficiency using their own prostheses to assess change over time. OBJECTIVES: (1) To describe prostheses and terminal device types used at baseline and 1-year follow-up; (2) to examine changes in functional outcomes and device satisfaction over time; and (3) to examine whether changes in outcomes varied across level of amputation and type of prosthesis used. STUDY DESIGN: Multisite, observational time series design with in-person functional performance and self-report data collected at baseline and 1-year follow-up. METHODS: Baseline and follow-up outcome scores were compared using Wilcoxon signed-rank tests. Analyses were stratified by amputation level, time since amputation, prosthesis type, and change in device type. Published minimal detectable change (MDC) values were used to determine whether detectable change in outcome measures occurred. RESULTS: The longitudinal cohort consisted of 64 participants (mean age 64 years, 56% body-powered users). The only significant differences in outcome measures between baseline and follow-up (after adjustment for false discovery) were hours/day of prosthesis use, which increased from 6.0 (4.4) to 7.3 (5.3) hours (P = 0.0022). Differences in prosthesis use intensity remained significant in analyses stratified by amputation level, time since amputation, prosthesis type, and change in device type. Between 14 and 20% of the sample had change in one or more outcome measures that was greater than the known MDC. CONCLUSIONS: Most participants had stable outcomes over a year's time, whereas 14-20% experienced either improvement or decline in one or more tests indicating the importance of annual follow-up visits.

The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.

OBJECTIVE: Amputation level decision making in patients with chronic limb threatening ischaemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result is significant variation in the distribution of amputation levels across health systems, geographical regions, and time. Clinical decision support has been shown to enhance decision making, especially complex decision making. The goal of this study was to translate the previously validated AMPREDICT prediction models by developing and testing the usability of the AMPREDICT Decision Support Tool (DST), a novel, web based, clinical DST that calculates individual one year post-operative risk of death, re-amputation, and probability of achieving independent mobility by amputation level. METHODS: A mixed methods approach was used. Previously validated prediction models were translated into a web based DST with additional content and format developed by an expert panel. Tool usability was assessed using the Post-Study System Usability Questionnaire (PSSUQ; a 16 item scale with scores ranging from 1 to 7, where lower scores indicate greater usability) by 10 clinician end users from diverse specialties, sex, geography, and clinical experience. Think aloud, semi-structured, qualitative interviews evaluated the AMPREDICT DST's look and feel, user friendliness, readability, functionality, and potential implementation challenges. RESULTS: The PSSUQ overall and subscale scores were favourable, with a mean overall total score of 1.57 (standard deviation [SD] 0.69) and a range from 1.00 to 3.21. The potential clinical utility of the DST included (1) assistance in counselling patients on amputation level decisions, (2) setting outcome expectations, and (3) use as a tool in the academic environment to facilitate understanding of factors that contribute to various outcome risks. CONCLUSION: After extensive iterative development and testing, the AMPREDICT DST was found to demonstrate strong usability characteristics and clinical relevance. Further evaluation will benefit from integration into an electronic health record with assessment of its impact on physician and patient shared amputation level decision making.

Amputation Care Quality and Satisfaction With Prosthetic Limb Services: A Longitudinal Study of Veterans With Upper Limb Amputation.

PURPOSE: This study sought to measure and identify factors associated with satisfaction with care among veterans. The metrics were colelcted for those receiving prosthetic limb care at the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) care settings and at community-based care providers. METHODS: A longitudinal cohort of veterans with major upper limb amputation receiving any VA care from 2010 to 2015 were interviewed by phone twice, 1 year apart. Care satisfaction was measured by the Orthotics and Prosthetics User's Survey (OPUS) client satisfaction survey (CSS), and prosthesis satisfaction was measured by the OPUS client satisfaction with device (CSD), and the Trinity Amputation and Prosthetic Experience Scale satisfaction scales. The Quality of Care index, developed for this study, assessed care quality. Bivariate analyses and multivariable linear regressions identified factors associated with CSS. Wilcoxon Mann-Whitney rank tests and Fisher exact tests compared CSS and Quality of Care items at follow-up for those with care within and outside of the VA and DoD. RESULTS: The study included 808 baseline participants and 585 follow-up participants. Device satisfaction and receipt of amputation care in the prior year were associated with greater satisfaction with care quality. Persons with bilateral amputation were significantly less satisfied with wait times. Veterans who received amputation care in the VA or DoD had better, but not statistically different, mean (SD) CSS scores: 31.6 (22.6) vs 39.4 (16.9), when compared with those who received care outside the VA or DoD. Those with care inside the VA or DoD were also more likely to have a functional assessment in the prior year (33.7% vs 7.1%, P = .06), be contacted by providers (42.7% vs 18.8%, P = .07), and receive amputation care information (41.6% vs 0%, P =.002). No statistically significant differences in CSS, Quality of Care scores, or pain measures were observed between baseline and follow-up. In regression models, those with higher CSD scores and with prior year amputation care had higher satisfaction when compared to those who had not received care. CONCLUSIONS: Satisfaction with prosthetic limb care is associated with device satisfaction and receipt of care within the prior year. Veterans receiving amputation care within the VA or DoD received better care quality scores than those receiving prosthetic care outside of the VA or DoD. Satisfaction with care and quality of care were stable over the 12 months of this study. Findings from this study can serve as benchmarks for future work on care satisfaction and quality of amputation rehabilitative care.

Telerehabilitation for Amputee Care.

Patients with amputation have unique characteristics and needs that must be considered when services are being provided through a virtual platform. The types of amputation rehabilitation services that can be provided virtually are numerous and vary from a full clinical team evaluation to individual therapy services. Whether services are being provided in person or through a virtual platform, rehabilitation of the person with amputation ideally involves a collaborative interdisciplinary team. The potential benefits of providing amputation rehabilitation care through a virtual platform include enhanced access to specialized services, reduced travel burden, and improved continuity of care.

Frequency and Severity of Phantom Limb Pain in Veterans with Major Upper Limb Amputation: Results of a National Survey.

OBJECTIVE: To describe the frequency and severity of phantom limb pain (PLP) in veterans with major upper limb amputation and determine the association between PLP and person, amputation, and prosthesis characteristics. DESIGN: Cross-sectional design. SETTING: National survey of veterans living in the community. PARTICIPANTS: U.S. military veterans (N = 776) with major upper limb amputations. MAIN OUTCOME MEASURES: Frequency and intensity of PLP, person characteristics such as age and gender, amputation characteristics such as level and etiology, and prosthesis characteristics such as type and intensity of prosthesis use. RESULTS: Respondents were 97% male with a mean age of 63 years and a mean time since amputation of 31 years. The most common amputation level was transradial (36%) and 62% reported accident as the amputation etiology. 73% of amputees reported PLP with a mean intensity score of 4.2 (standard deviation 3.4). PLP frequency in the daily to always category was reported in 42% of amputees. Weekly and more frequent residual limb pain was associated with having any PLP. Amputation at the shoulder (odds ratio [OR] 3.78 [1.93, 7.39]), amputation at the transhumeral level (OR 1.76 [1.10,2.81]), and amputation due to cancer (OR 5.33 [1.15, 24.81]) were also associated with any PLP. Moderate (ß = 1.34, P = < .001) and severe (ß = 3.31, P < .001) residual limb pain intensity was associated with higher PLP intensity among those with pain. Amputation at the shoulder level was associated with a 1.5 points higher average pain intensity score (P < .001) compared to the transradial level. Multivariable models failed to show an association between PLP prevalence and amputation of the dominant limb (P = .08) and PLP was not associated with intensity of daily prosthesis use in bivariate analyses. CONCLUSION: This study of a large cohort of veterans with major upper limb amputation highlights the long-term persistence of moderate frequency and intensity PLP.

Embodied apocalypse: or the native cosmology of late modern social theory.

The Brethren communities of Scotland's northeast coast inhabit a world that is both modern and enchanted; a state of affairs made possible due to the ways in which life as a deep sea fishermen relate to life as a millenarian Protestant. This article argues that the connection between a life at sea and life in the Brethren is a search for 'signs of the times' - in storms, hauls of prawns, EU fisheries legislation, and so on - which, when taken together, collectively evidence to the Brethren the fact that the end of the world is near. More than this, by extending the eschatological observations of my informants, I want to suggest that this kind of apocalyptic sign searching can also be seen as a feature of what some social theorists - most prominent among them, Ulrich Beck, Anthony Giddens, Scott Lash, and Zygmunt Bauman - refer to as 'late' or 'liquid' modernity, whereby, in its most radical formulation, the cosmos is effectively reduced to the size of the individual.

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs.

BACKGROUND: The goal of the US Department of Veterans Affairs (VA) Amputation System of Care (ASoC) is to enhance the quality and consistency of amputation rehabilitation care for veterans with limb loss. OBJECTIVE: The ASoC provides specialized expertise in amputation rehabilitation incorporating the latest practices in medical management, rehabilitation, and artificial limbs in order to minimize disability and to enable the highest level of social, vocational, and recreational success for veterans with amputation. DISCUSSION: The ASoC serves veterans with limb amputation from any etiology. Between 2009 and 2019, the VA experienced a 34% increase in the number of veterans with amputation who received care. During the same 10-year period, the percentage of veterans with major limb amputation seen in an outpatient amputation specialty clinic each year increased from 4.8 to 26%. This article highlights how the mission of the ASoC has been accomplished over the past decade through prioritization and implementation of key strategic initiatives in learning organization creation, trust in VA care, modernization, and development of a high-performance network with enhanced access and customer service. CONCLUSIONS: This synopsis of the VA amputation care program serves as a model of amputation care that can be utilized outside the federal sector and has the potential to serve as a systems-based example for providing longitudinal care to other populations within the VA.

Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation: An Update from the Department of Veterans Affairs and Department of Defense.

Between 2015 and 2017, the US Department of Veterans Affairs and the US Department of Defense developed a clinical practice guideline for rehabilitation of lower limb amputation to address key clinical questions. A multidisciplinary workgroup of US Department of Veterans Affairs and US Department of Defense amputation care subject matter experts was formed, and an extensive literature search was performed which identified 3685 citations published from January 2007 to July 2016. Articles were excluded based on established review criteria resulting in 74 studies being considered as evidence addressing one or more of the identified key issues. The identified literature was evaluated and graded using the National Academies of Science GRADE criteria. Recommendations were formulated after extensive review. Eighteen recommendations were confirmed with four having strong evidence and workgroup confidence in the recommendation. Key recommendations address patient and caregiver education, consideration for the use of rigid and semirigid dressings, consideration for the use of microprocessor knees, and managed lifetime care that includes annual transdisciplinary assessments. In conclusion, this clinical practice guideline used the best available evidence from the past 10 yrs to provide key management recommendations to enhance the quality and consistency of rehabilitation care for persons with lower limb amputation.

Department of Veterans Affairs Polytrauma Telerehabilitation: Twenty-First Century Care.

The use of telehealth for the management of the polytrauma patient provides a unique opportunity to leverage technology to enhance care for a complex patient cohort, to assist in clinical care, and to enhance support for community reintegration for veteran patients. Telehealth connects experts to patients in remote or underserved areas, thereby decreasing a health care disparity. This is especially important when the rehabilitation team is multidisciplinary. The future of telerehabilitation is unknown and implementing virtual care into rehabilitation providers' standard practice will be impeded until state licensure and payment issues are resolved.

Reintegrating Veterans with Polytrauma into the Community and Workplace.

This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.

Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations.

Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.

Gait and Functional Outcomes for Young, Active Males With Traumatic Unilateral Transfemoral Limb Loss.

OBJECTIVE: Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous studies describing these outcomes are typically limited by number of outcome measures and/or small, diverse patient groups, recent military conflicts present a unique opportunity to collect outcomes from a relatively homogenous, active patient population with limb loss. Thus, the objective of this study is to provide reference outcome measures on the basis of a large, relatively homogenous cohort of military personnel with transfemoral limb loss. METHODS: A retrospective review of biomechanical, physiological, functional, and subjective measures was completed for 67 male servicemembers who sustained an injury resulting in traumatic, transfemoral limb loss during recent conflicts. These individuals represent a defined cohort, capable of exhibiting improved clinical outcomes resulting from demographic characteristics and extensive rehabilitation. Biomechanical and physiological outcome measures for 76 uninjured male servicemembers are also provided to serve as normative reference for full return to function. Select biomechanical and physiological outcomes related to stability, overuse, and efficiency are discussed in the text, on the basis of relevance to clinical gait assessment, in addition to functional and subjective measures. RESULTS: In general, individuals with transfemoral limb loss exhibit decreased stability relative to uninjured individuals, noted by larger peak trunk velocity and step width variability; increased risk of low back and knee joint pain and/or degeneration, noted by larger trunk lateral flexion and bending moments, as well as larger vertical ground reaction force (vGRF) loading rates and impulses, respectively; and decreased efficiency during gait, noted by larger oxygen costs and leading limb mechanical work. CONCLUSION: Although the comprehensive set of measures presented here indicates overall reductions in biomechanical and functional performance with transfemoral limb loss compared to uninjured individuals, these reductions were relatively smaller than existing evidence among populations that are more diverse in age and activity level. Therefore, this data set may be used as benchmarks for young, active individuals with transfemoral limb loss, to assist with setting clinical goals, and to aid in the evaluation of new treatment techniques or interventions. These measures will also be particularly important for subsequent evaluations and longitudinal follow-ups to determine the longer-term impact of transfemoral limb loss on this cohort.