Differences in prosthetic prescription between men and women Veterans following transtibial or transfemoral lower extremity amputation: a longitudinal cohort study (2005-2018).

Littman AJ, Peterson AC, Korpak A, Czerniecki JM, Turner A, Norvell DC, Williams RM, Lehavot K. Differences in prosthetic prescription between men and women Veterans following transtibial or transfemoral lower extremity amputation: a longitudinal cohort study (2005-2018). Archives of physical medicine and rehabilitation. 2023 Mar 9.

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Abstract:

OBJECTIVE: To evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors. DESIGN: Retrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases. SETTING: VHA patients throughout the United States. PARTICIPANTS: The sample included 20,889 men and 324 women who had an incident transtibial or transfemoral amputation between 2005 and 2018. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time to prosthetic prescription (up to one year). We used parametric survival analysis (an accelerated failure time [AFT] model) to assess gender differences. We estimated mediation effects of amputation level, pain comorbidity burden, medical comorbidities, depression, and marital status on time to prescription. RESULTS: In the 1 year after amputation, the proportion of women (54.3%) and men (55.7%) prescribed a prosthesis was similar. However, after controlling for age, race, ethnicity, enrollment priority, VHA region, and service-connected disability, the time to prosthetic prescription was significantly faster among men compared to women (Acceleration factor = 0.71, 95% CI 0.60-0.86). The difference in time to prosthetic prescription between men and women was significantly mediated by amputation level (19%), pain comorbidity burden (-13%), and marital status (5%), but not medical comorbidities or depression. CONCLUSION: Though the proportion of patients with prosthetic prescription at 1-year post-amputation was similar between men and women, women received prosthetic prescriptions more slowly than men, suggesting that more work is needed to understand barriers to timely prosthetic prescriptions among women, and how to intervene to reduce those barriers.