Amputee Clinic Research Articles

Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users

ObjectiveTo determine normal variation in walking metrics in a population of lower limb amputees who use lower limb prostheses over a 6-month period and to provide a means to interpret clinically meaningful change in those community walking metrics. DesignProspective cohort study monitoring walking behavior and subjective and objective measures of activity. SettingVeterans Administration and university amputee clinics. Participants86 individuals with lower limb amputation who use protheses. InterventionsStepWatch activity monitor tracked subjects’ walking for 24 weeks; Global Mobility Change Rating collected weekly. Main Outcome MeasuresAssociation between change in Global Mobility Change Rating and change in any of the walking metrics. ResultsWalking metrics including step count, cadence, cadence variability, and walking distance in a population of lower limb prosthesis users were obtained. There was a high correlation in the walking metrics indicating higher function with higher functional classification level (K-levels) but also substantial overlap in all metrics and a very weak correlation between subject-reported activity level and objective measures of walking performance. ConclusionThe overlap in walking metrics with all K-levels demonstrates that no single metric measured by StepWatch can determine K-level with 100% accuracy. As previously demonstrated in other populations, subjects’ interpretations of their general activity level was inaccurate, regardless of their age or activity level. Objective measures of walking appear to provide a more accurate representation of patients’ activity levels in the community than self-report. Therefore, objective measures of walking are useful in supporting K-level determinations. However, clinicians cannot rely on a single metric to determine K-level.

"To Conserve Fighting Strength": The Role of Military Culture in the Delivery of Care.

There are ongoing discussions about reorganizing the delivery of health care within the US Armed Forces. The military cultural context of care has beneficial qualities for patients with orthopedic and extremity trauma acquired during deployments to conflict zones. The study included 35 participants with lower limb amputations who had been discharged from the Amputee Patient Care Program ≥ 12 months prior to the study. Participants were interviewed using a lightly structured schedule designed to elicit accounts of community integration, which attended to reports of belongingness supported by accounts of social engagement in work, school, family, and social events. Interviews were analyzed using a modified content analysis approach. Participants generally described their postcare lives as "successful" that had been built on "good outcomes." For most former patients, remembering the social intensity of their rehabilitation program was an important element in their narratives of recovery. Weekly amputee clinics worked to alleviate stress and anxiety in participants' minds around the complexities of their injuries and care. Participants reported that features of their care were particularly valuable to their recovery and their current assessment of their injury related health. These features are present, in part because of the military cultural context that is part of the framework of care delivery.

Benchmarking Residual Limb Pain and Phantom Limb Pain in Amputees through a Patient-reported Outcomes Survey.

Background:More than 75% of major limb amputees experience chronic pain; however, data on severity and experience of pain are inconsistent. Without a benchmark using quantitative patient-reported outcomes, it is difficult to critically assess the efficacy of novel treatment strategies. Our primary objective is to report quantitative pain parameters for a large sample of amputees using the validated Patient-reported Outcomes Measurement System (PROMIS). Secondarily, we hypothesize that certain patient factors will be associated with worse pain.Methods:PROMIS and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained from a cross-sectional survey of upper and lower extremity amputees recruited throughout North America via amputee clinics and websites. Demographics (gender, age, race, and education) and clinical information (cause, amputation level, and time since amputation) were collected. Regression modeling identified factors associated with worse pain scores (P < 0.05).Results:Seven hundred twenty-seven surveys were analyzed, in which 73.4% reported RLP and 70.4% reported PLP. Median residual PROMIS scores were 46.6 [interquartile range (IQR), 41–52] for RLP Intensity, 56.7 (IQR, 51–61) for RLP Behavior, and 55.9 (IQR, 41–63) for RLP Interference. Similar scores were calculated for PLP parameters: 46.8 (IQR, 41–54) for PLP Intensity, 56.2 (IQR, 50–61) for PLP Behavior, and 54.6 (IQR, 41–62) for PLP Interference. Female sex, lower education, trauma-related amputation, more proximal amputation, and closer to time of amputation increased odds of PLP. Female sex, lower education, and infection/ischemia-related amputation increased odds of RLP.Conclusion:This survey-based analysis provides quantitative benchmark data regarding RLP and PLP in amputees with more granularity than has previously been reported.

Focused Amputee Clinics: The need of the hour.

Focused Amputee Clinics: The need of the hour.

Education Level Among Patients with Major Limb Amputation.

IntroductionDespite all the advances in medicine and attempts to delay and prevent amputations, the number of amputations remains high. The state of South Carolina has one of the highest rates of major limb amputation in the country, with Florence and neighboring counties particularly affected. Education level has been associated with an increased number of amputations and worse outcomes post-amputation. The aim of this study was to investigate the education level among patients with major upper and lower limb amputation within the Florence and neighboring counties, which is a part of the Pee Dee region of the state of South Carolina.Materials and methodsThis is a retrospective chart review study conducted at the outpatient hospital-based Physical Medicine and Rehabilitation clinic. All consecutive amputee patients visiting our outpatient amputee clinic from January 2018 to January 2019 and who met the study inclusion criteria were included in the study. The main outcome measure was the education level.ResultsOf the sample, 26% had below high school education, 33.8% had high school education, 14.2% had some college education, 19.7% had a college education, and 6.3% had an advanced college degree.ConclusionsPatients with major limb amputation have a lower education level compared to the general population. Lower education level as a part of the broader and more complex socioeconomic status may be a possible barrier in the process of post-amputation rehabilitation and long-term care of patients with major limb amputation.

The use of and satisfaction with prosthesis and quality of life in patients with combat related lower limb amputation, experience of a tertiary referral amputee clinic in turkey

The use of and satisfaction with prosthesis and quality of life in patients with combat related lower limb amputation, experience of a tertiary referral amputee clinic in turkey

Comparing the Effects of Dual-Task Gait Testing in New and Established Ambulators With Lower Extremity Amputations

BackgroundGait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm. ObjectiveTo investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations. DesignCross-sectional study. SettingOutpatient and inpatient amputee clinics at an academic rehabilitation hospital. ParticipantsSixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas). InterventionsNot applicable. Main Outcome MeasuresTime to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs. ResultsGait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P < .001), TTA-nonvas (P < .001), and NewPA groups (P < .001). However, there was no between-group difference for gait DTC. The 3 groups tested did not differ in the amount of cognitive DTC (DTCcog). Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P < .001). The TTA-vas group had a slight improvement during dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many individuals had a decrease in performance on both tasks; however, the gait task was prioritized for the majority (56.2%) of participants. ConclusionsCognitive distractions while walking pose challenges to individuals regardless of etiology, level of amputation, or time with the prosthesis. These findings highlight that individuals are at risk for adverse events when performing multiple tasks while walking. Level of EvidenceII

Differences in Physical Performance Measures Among Patients With Unilateral Lower-Limb Amputations Classified as Functional Level K3 Versus K4

ObjectiveTo determine whether differences in physical function, assessed via self-report questionnaires and physical performance tests, exist between individuals with lower-limb loss using a prosthetic device classified as a K3 versus a K4 functional level. DesignCross-sectional study. SettingA university physical therapy amputee clinic. ParticipantsParticipants (N=55) were included if they (1) were aged ≥18 years with a unilateral transfemoral or transtibial amputation; (2) were classified as K3 or K4 functional level; (3) completed all relevant outcome measures; and (4) were currently using a prosthesis. InterventionsNot applicable. Main Outcome MeasuresLocomotor Capabilities Index (LCI), Prosthetic Evaluation Questionnaire–Mobility Section (PEQ-MS), Timed Up and Go (TUG), 10-Meter Walk Test (10MWT), Amputee Mobility Predictor (AMPPRO), and 6-Minute Walk Test (6MWT). K level was determined by group consensus based on a standardized clinical evaluation. ResultsAfter controlling for covariates, patients classified as K3 had slower TUG times (P=.002) and self-selected and fast gait speeds (P<.001), lower AMPPRO scores (P<.001), and walked shorter distances during the 6MWT (P=.003) when compared with patients classified as K4. No significant between-group differences for the LCI or PEQ-MS were found. ConclusionsClinicians involved in prosthetic prescription may consider including the TUG, 10MWT, AMPPRO, and 6MWT during their clinical evaluations to help differentiate between individuals of higher functional mobility. The LCI and PEQ-MS may be less useful in classifying individuals as K3 versus K4 because of a ceiling effect.

Determining Reliability of a Dual-Task Functional Mobility Protocol for Individuals With Lower Extremity Amputation

ObjectiveTo determine the relative and absolute reliability of a dual-task functional mobility assessment. DesignCross-sectional study. SettingAcademic rehabilitation hospital. ParticipantsIndividuals (N=60) with lower extremity amputation attending an outpatient amputee clinic (mean age, 58.21±12.59y; 18, 80% male) who were stratified into 3 groups: (1) transtibial amputation of vascular etiology (n=20); (2) transtibial amputation of nonvascular etiology (n=20); and (3) transfemoral or bilateral amputation of any etiology (n=20). InterventionsNot applicable. Main Outcome MeasuresTime to complete the L Test measured functional mobility under single- and dual-task conditions. The addition of a cognitive task (serial subtractions by 3's) created dual-task conditions. Single-task performance on the cognitive task was also reported. Intraclass correlation coefficients (ICCs) measured relative reliability; SEM and minimal detectable change with a 95% confidence interval (MDC95) measured absolute reliability. Bland-Altman plots measured agreement between assessments. ResultsRelative reliability results were excellent for all 3 groups. Values for the dual-task L Test for those with transtibial amputation of vascular etiology (n=20; mean age, 60.36±7.84y; 19, 90% men) were ICC=.98 (95% confidence interval [CI], .94–.99), SEM=1.36 seconds, and MDC95=3.76 seconds; for those with transtibial amputation of nonvascular etiology (n=20; mean age, 55.85±14.08y; 17, 85% men), values were ICC=.93 (95% CI, .80–.98), SEM=1.34 seconds, and MDC95=3.71 seconds; and for those with transfemoral or bilateral amputation (n=20; mean age, 58.21±14.88y; 13, 65% men), values were ICC=.998 (95% CI, .996–.999), SEM=1.03 seconds, and MDC95=2.85 seconds. Bland-Altman plots indicated that assessments did not vary systematically for each group. ConclusionsThis dual-task assessment protocol achieved approved levels of relative reliability values for the 3 groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the population with lower extremity amputation.

Feasibility testing of smart tablet questionnaires compared to paper questionnaires in an amputee rehabilitation clinic

Capturing the variability that exists among patients attending an amputee clinic using standardized paper-based questionnaires is time-consuming and may not be practical for routine clinical use. Electronic questionnaires are a potential solution; however, the benefits are dependent on the feasibility and acceptance of this mode of data collection among patients. To determine the feasibility and patient preference/comfort in using a tablet-based questionnaire for data collection in an outpatient amputee rehabilitation clinic compared to a traditional paper-based questionnaire. Observational study. In all, 48 patients with major extremity amputations completed both tablet and paper questionnaires related to their amputation and prosthetic use. Both trials were timed; patients then completed a semi-structured questionnaire about their experience. In all, 20.5% of patients needed hands-on assistance completing the paper questionnaire compared to 20.8% for the tablet. The majority of participants (52.1%) indicated a preference for the tablet questionnaire; 64.6% of patients felt the tablet collected a more complete and accurate representation of their status and needs. In all, 70.8% of participants described themselves as comfortable using the tablet. Despite comorbidities, patients with amputations demonstrated excellent acceptance of the electronic tablet-based questionnaire. Tablet questionnaires have significant potential advantages over paper questionnaires and should be further explored. Clinical relevance A custom electronic questionnaire was found to be beneficial for routine clinic use and was well received by patients in an amputee rehabilitation clinic. Development of such questionnaires can provide an efficient mechanism to collect meaningful data that can be used for individual patient care and program quality improvement initiatives.

Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees.

To describe the outcomes of traction neurectomy as a surgical treatment for symptomatic neuroma of the residual lower extremity and to identify clinical and/or demographic factors associated with an increased likelihood of persistent or recurrent pain after surgery. Retrospective Cohort Study. Amputee clinic at a Level I Trauma Center. Inclusion required a history of transfemoral or transtibial amputation and a history of symptomatic neuroma(s) at the residual limb treated with traction neurectomy. Twelve months of clinical follow-up or the recurrence of neuroma-type pains was required for inclusion. Thirty-eight patients (63 nerves) comprised the study group. Traction neurectomy for treatment of symptomatic neuroma. The primary outcome was the presence or absence of persistent or recurrent neuroma-type pain at last follow-up. The secondary outcome was reoperation for persistent or recurrent symptomatic neuroma. Sixteen of 38 patients (42%) had recurrent or persistent neuroma-type pain at a mean follow-up of 37 months (range, 11-91 months), and 8/38 (21%) have undergone subsequent surgical treatment. Among the demographic and clinical features examined, only male gender was found to be a statistically significant predictor of persistent or recurrent neuroma-type pain. Traction neurectomy results in a high rate of persistent or recurrent neuroma-type and that surgeons should be cautious when considering it for the treatment of symptomatic neuroma of the residual lower extremity. Furthermore, efforts to identify better surgical and nonsurgical treatments for this problem are justified. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation.

To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

Heterotopic Ossification in Civilians With Lower Limb Amputations

ObjectivesTo report the incidence of symptomatic heterotopic ossification (HO) in a defined civilian amputee population, describe its characteristics, and compare these findings to published data in military amputees. DesignRetrospective chart analysis from July 1998 to July 2009. SettingAmbulatory amputee clinic within a large university medical center. ParticipantsAdults with lower limb amputation (N=158). InterventionsNot applicable. Main Outcome MeasurePatients with symptomatic HO confirmed by radiographs. ResultsA total of 261 patients were evaluated; 158 met inclusion criteria, with 59% having traumatic etiology, 18% vascular etiology, 22% infection, and 1% tumor. Symptomatic HO was diagnosed in 36 (22.8%) patients, and 94% patients had mild HO on radiographic scoring. Rate of HO in amputations related to trauma was not increased compared with those of other etiologies. Surgical resection of the ectopic bone was required in 4 (11%) patients. ConclusionsHO is seen commonly after civilian lower limb amputation regardless of etiology. The prevalence was less than that observed in previous reports from military populations. This is the first report estimating the prevalence of HO in adult civilian amputees.

An Update on Major Lower Limb Amputation in Nigeria

This paper is our recent review of literatures on lower limb amputation in Nigeria. There is no national data on the incidence of amputation in Nigeria. Its management remain a major health problem in our society. Amputee in Nigeria is often confronted with the physical reality of mutilation and the stigma attached to it, making it difficult for patients to accept the therapeutic value of amputation unless they perceive an obvious threat to life. The pattern of indications vary from place to place and seems to be changing. Rehabilitation of amputees is a major problem in Nigeria. It is multidisciplinary and should begin from the time the decision is made. This should be co-ordinated in a well organized amputee clinic. Most of the amputees do not have access to prosthesis so they hop around with the aid of sticks, crutches and join the colony of beggars and destitute in our streets. Efforts should be channelled towards preventing limb losses and reducing the burden on amputees through the initiation of new and enforcement of existing health policies in Nigeria.

Radiographic parameters improve lower extremity prosthetic alignment

The goal of prosthetic fitting is to provide comfort and functionality to the patient. It is thought that incorporating the use of standing anterior-posterior long leg radiographs (LLR) into the fitting of lower extremity prostheses will provide an objective guide when making adjustments, and be a better assessment of alignment. This study compares prosthetic alignment before and after radiography-guided adjustments. This retrospective study was performed at a multidisciplinary amputee clinic on patients with congenital and/or acquired limb deficiencies. Their prosthetic alignment was evaluated by LLR and adjusted as needed. Satisfactory alignment was defined as a mechanical axis angular deviationof ≤1° and a leg length discrepancyof ≤10mm. A total of 45 unique prostheses from 24 subjects (10 female and 14 male) were included. Post-adjustment radiographs were obtained from 29 prostheses. After the initial prosthetic fitting, the probability of a satisfactory fit was 20.0% (95% CI 10.9-34.9%). Following the baseline adjustment, the probability of a satisfactory fit improved to 53.3% (95% CI 37.5-70.9%). After adjustment number 4, the probability of a satisfactory fit further improved to 76.7% (95% CI 41.9-98.0%). There were also significant improvements in distal offset distance (p=0.0040) and leg length discrepancy (p=0.0206). The distal offset distance decreased by an average of 10.7mm (95% CI 3.6-17.8), and leg length discrepancy decreased by an average of 3.0mm (95% CI 00.48-5.5). The addition of LLRs to existing fitting methods significantly improves prosthetic alignment and length.

A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation

Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process. Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified. Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patient's expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation. The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others' opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.

Rasch Analyses of the Activities-specific Balance Confidence Scale With Individuals 50 Years and Older With Lower-Limb Amputations

Sakakibara BM, Miller WC, Backman CL. Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations. Objectives To explore shortened response formats for use with the Activities-specific Balance Confidence (ABC) Scale and then evalute the unidimensionality of the scale, the item difficulty, the scale for redundancy and content gaps, and the item standard error of measurement (SEM) and internal consistency reliability among aging individuals with a lower-limb amputation living in the community. Design Secondary analysis of cross-sectional survey and chart review data. Setting Outpatient amputee clinics, Ontario, Canada. Participants Community living adults (N=448; ≥50y; mean, 68y) who have used a prosthesis for at least 6 months for a major unilateral lower-limb amputation. Of the participants, 325 (72.5%) were men. Interventions Not applicable. Main Outcome Measure ABC Scale. Results A 5-option response format outperformed 4- and 6-option formats. Factor analyses confirmed a unidimensional scale. The distance between response options is not the same for all items on the scale, evident by the Rasch Partial Credit Model (PCM) having a better fit to the data than the Rasch Rating Scale Model. Two items, however, did not fit the PCM within statistical reason. Revising the wording of the 2 items may resolve the misfit and improve the construct validity and lower the standard error of measurement. Overall, the difficulty of the scale's items is appropriate for use with aging individuals with lower-limb amputation, and is most reliable (Cronbach α=0.94) for use with individuals with moderately low balance confidence levels. Conclusions The ABC Scale with a simplified 5-option response format is a valid and reliable measure of balance confidence for use with individuals aging with a lower-limb amputation.

A cross-sectional study of post-amputation pain in upper and lower limb amputees, experience of a tertiary referral amputee clinic

Purpose. To determine the pain characteristics and health-related quality of life (HR-QOL) of upper and lower limb amputees.Method. Amputees attending the Prince of Wales Prosthetic Clinics in 2006 were administered a questionnaire survey of their pain experiences, Short form McGill pain questionnaire, Short Form 36 (SF 36) and Pain Self-Efficacy Questionnaire (PSEQ).Results. Of the 17 who were upper limb amputees (including the two multiple limb amputees), only 1 was pain free and of the 39 who were lower limb amputees 14 were pain free. Upper limb amputees experienced significantly greater proportion, frequency and severity of post-amputation pain than lower limb amputees. The presence of significant pre-operative pain did not correlate with the development of persistent post-amputation pain. In quality of life measures, the amputees experienced a better physical function, role physical and confidence in performance of activities than chronic pain patients attending the pain clinic. Lower limb amputees fared better than upper limb amputees in terms of bodily pain, social function and mental health. However, the amputee groups have a reduced health status in almost all domains compared to the aged matched Australian population norm.Conclusions. The study suggests that upper limb amputees are significantly more likely to suffer post-amputation pain which is more frequent, longer lasting and more severe in intensity when compared to lower limb amputees. This is accompanied by reduced HR-QOL especially that related to bodily pain, social function and mental health. The overall health status of amputees are also significantly lower compared to the Australian population norm.

Quality of medical care provided to service members with combat-related limb amputations: Report of patient satisfaction

A group of 158 service members who sustained major limb amputations during the global war on terrorism were surveyed on their satisfaction with the quality of care received from the Walter Reed Army Medical Center (WRAMC) Amputee Clinic from the time of their injury to their inpatient discharge. Of these participants, 96% were male, 77% were Caucasian, 89% were enlisted personnel, and 68% had sustained lower-limb amputations. WRAMC inpatient therapy, peer visitors, overall medical care, and pain management received particularly high satisfaction ratings. Age, race, rank, and level and side of amputation had little effect on overall satisfaction ratings. Significant differences, however, were found by location of injury (Iraq vs Afghanistan, Cuba, and Africa) regarding satisfaction with care received while in Europe and with the education process at WRAMC. Study findings strongly support the rehabilitation-based, integrative care approach designed by the U.S. military to care for service members with amputations.

The Experience of Phantom Limb Pain in Patients With Combat-Related Traumatic Amputations

Ketz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Objectives To describe the prevalence and characteristics of phantom limb pain (PLP) and the use and perceived effectiveness of standard medical and self-treatment methods by traumatic amputees with combat-related injuries. Design A retrospective descriptive questionnaire study. Setting Outpatient amputee clinic at a major military medical center. Participants Convenience sample of military members (N=30) with single or multiple traumatic amputations from combat and/or training. Inclusion criteria were 18 to 50 years old and amputation within 5 years of the study. Exclusion criteria were nontraumatic amputees and amputation or most recent surgical revision within 3 months before the study. Interventions Not applicable. Main Outcome Measures The primary dependent variables were pain and relief, as measured by an investigator-developed questionnaire. Results Seventy-seven percent of participants experienced PLP at some time since their amputation. Of those with PLP, the mean average intensity was 3.3±2.0 out of 10 and the mean worst intensity was 5.4±2.6 out of 10. The PLP was intermittent, and 78% reported episodes of PLP at least weekly. Sixty-eight percent of participants with PLP were receiving treatment from their health care providers. The most common medical treatment was gabapentin, although some patients reported greater pain relief from self-treatment methods such as distraction and relaxation techniques. Conclusions With over 750 service members living with amputations from recent combat, PLP will continue to be a troubling problem that requires effective interventions. The discrepancy between perceived effectiveness of different treatment types supports the need for highly individualized pain management plans.