Strength, Pain and Function in Operation Iraqi Freedom/Operation Enduring Freedom Amputees: A Nurse-Managed Program

• lower extremity muscle strength and mobility [ Time Frame: Strength: 0, 3, 6-7, 9, 13 wks; Mobility 7, 13 weeks ] [ Designated as safety issue: No ]
  

• Quality of life and symptoms associated with residual limb and phantom pain [ Time Frame: QOL: 0, 7, 13 wks; Symptoms: 0, 3, 6-7, 9, 13 wks ] [ Designated as safety issue: No ]
  

Traumatic amputation is one of the major injuries seen as a result of Operation Iraqi and Enduring Freedom with the majority being single trans-tibial amputations (TTA). TTA experience significant reductions in thigh muscle strength of the amputated limb during the first year after amputation. The residual limb is less active in daily functions of standing and walking, resulting in progressive atrophy of the quadriceps muscles in terms of a decrease in thigh diameter which is estimated at 25% of pre-amputation diameter. An intervention that may be useful in TTA rehabilitation (rehab) is neuromuscular electrical stimulation (NMES). The overall objectives of this study is to test two different approaches to prosthetic rehab as potential treatments for improving muscle strength, pain and functional performance of daily activities in military personnel with TTA. Our central hypothesis is that a Nurse Managed NMES Rehab Program will have greater improvements in muscle strength and pain as compared to the standard rehab protocol alone. The rationale for this study is that NMES could have an additive effect to the WRAMC standard of care program with greater improvements in muscle strength thus enhancing the performance of daily activities, Quality of Life (QOL), and decreasing disability. Such outcomes will ultimately result in decreased economic costs, accelerated rehab, and potentially increase the possibility of these warriors returning to duty. The specific aims are to test Nurse Managed NMES relative to standard rehabilitation by comparing: (1) Lower extremity muscle strength; (2) QOL; and (3) Symptoms associated with phantom pain. In addition to the above aims, specific aims for the post prosthetic phase of the intervention are to compare the two groups for (4) functional performance of daily activities. After pre-testing, participants aged 18 to 55 yrs with a traumatic TTA will be randomly assigned to either the 1) Nurse Managed NMES Rehab Program (n=30); or 2) WRAMC Amputee Protocol (n=30). Those in the NMES group will receive 12 weeks of electrical muscle stimulation 15 min/day, 5 days a week for 12 weeks. Both groups will receive the standard 12-week WRAMC rehab protocol. GEE methods will be used to build regression models for statistical analysis of the longitudinal data. The significance of this research is that Nurse Managed NMES may be very important for accelerating the rehab of amputees so they can achieve functional independence and regain lost muscle strength in preparation for return to duty.