It’s well documented that race, income, geography, and other factors can have a huge impact on individual amputees’ health status. But there’s another fault line in patient outcomes, according to two new studies: sex.
According to public health researchers at the University of Michigan, women are far more likely than men to wait 90-plus days after lower-limb amputation to receive a prosthesis. That conclusion is based on seven years’ worth of insurance data, encompassing more than 4,000 patients—a hearty sample size. Nearly 40 percent of men who received a prosthesis did so within 90 days, versus only 30 percent of women. With a bit of statistical analysis, the authors estimated that women wait, on average, 33 percent longer than men to receive their first prosthesis—i.e., a 90-day wait for a man translates into a 120-day wait for a woman.
What are the implications of such a pause? Delayed prosthesis acquisition is correlated with all sorts of adverse outcomes, including device abandonment, reduced mobility, lower quality of life, and decline in overall health indicators. According to a 2020 paper, longer waits prior to prosthetic fitting drive up healthcare costs by roughly 25 percent due to increased postsurgical complications, rehospitalizations, fall-related injuries, and other problems.
A second study, which is summarized in the April edition of Archives of Physical Medicine and Rehabilitation, found that women report significantly worse satisfaction with their prostheses than men. Based on a survey of 231 amputees (128 women, 103 men), the project addressed a range of indicators, including body image, activity level, functionality, social adjustment, and aesthetic factors.
“Preliminary analyses indicate that women with limb loss have unique physical and psychosocial needs, thus challenging providers for women with limb loss to evolve healthcare delivery and research practices, as well as work jointly with industry in order to meet the unique needs of this population,” noted the authors, a multidisciplinary team of clinicians affiliated with the James J. Peters VA Medical Center in New York City.
Although both studies are still in preliminary form, their conclusions appear well founded. And they’re consistent with a 2021 paper that appeared in the Journal of Vascular Surgery, which found that women are less likely than men to get referred to a prosthetist in the first place. So the issue of sex inequity in limb care clearly bears further investigation.
With High-Tech Limbs, Perception ≠ Reality
More advanced prosthetic limbs translate into better mobility, right? According to a recent study of prosthesis satisfaction in lower-limb amputees, it depends who you ask.
Researchers at the VA Center for Limb Loss and MoBility (CLiMB) found that above-knee amputees with high-tech prostheses were more mobile than patients with basic models, based on objective measurements. Subjectively, however, wearers of more advanced limbs didn’t feel more mobile; they were no more satisfied with their mobility than above-knee amputees with more basic devices.
For below-knee amputees, the opposite was true: Patients with more advanced prostheses weren’t objectively more mobile than patients with basic models, yet they expressed greater satisfaction with their mobility. Go figure.
The study, due to be published in an upcoming edition of Archives of Physical Medicine and Rehabilitation, was based on surveys of roughly 350 veterans who underwent lower-limb amputations due to diabetes and/or peripheral artery disease. The authors’ takeaway: “Further research is needed to understand the relation between mobility level of satisfaction with mobility.”
