Effectiveness of individualized occupational therapy interventions without the use of prosthetics for military servicemen with unilateral upper extremity amputations

Anna Postonogova; Oleksandra Kalinkina; Kostiantyn Kalinkin; Iryna Zharova; Olexii Nikanorov

doi:10.15391/prrht.2025-10(5).03

Authors

Anna Postonogova Ukrainian Society of Ergotherapists, Zhytomyr, Ukraine https://orcid.org/0009-0000-2004-8800
Oleksandra Kalinkina Department of Therapy and Rehabilitation, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine https://orcid.org/0000-0003-4453-375X
Kostiantyn Kalinkin Department of Therapy and Rehabilitation, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine https://orcid.org/0000-0003-0668-2906
Iryna Zharova Department of Therapy and Rehabilitation, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine https://orcid.org/0000-0002-8904-9446
Olexii Nikanorov Department of Therapy and Rehabilitation, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine https://orcid.org/0000-0002-5326-0979

DOI:

https://doi.org/10.15391/prrht.2025-10(5).03

Keywords:

occupational therapy, military servicemen, upper extremity amputations, COPM, DASH, quality of life

Abstract

Purpose. This paper presents the results of an experimental study investigating the effectiveness of individualized occupational therapy interventions for people with upper limb amputations without the use of prosthetic devices. This study is relevant because the number of people in Ukraine who have had a limb amputated as a result of the ongoing war is increasing, as is the need for effective rehabilitation methods to improve quality of life.

Material & Methods. The study employed a pre-test–post-test experimental design, allowing for the evaluation of changes in participants’ functional status and occupational performance following a structured occupational therapy intervention without prosthetic devices. Occupational therapy sessions were aimed at client education and teaching the clients new skills to use modified and compensatory strategies for task performance, adaptive equipment, as well as making adaptation of the environment for increased functional independence. Participants included 10 male military servicemen between the ages of 20 and 45 years old with upper extremity amputations who participated in occupational therapy interventions for two months. The assessment was carried out using the Canadian Occupational Performance Measure (COPM), Disabilities of Arm, Shoulder and Hand (DASH) questionnaire and Visual Analogue Scale (VAS). Statistical data were analyzed using descriptive statistics and paired samples t-test.

Results. As a result of the occupational therapy interventions, the study participants demonstrated a statistically significant decrease in disability levels according to the DASH, as evidenced by an average score decrease from 80.5 prior to intervention to 44.2 post-intervention (p<.001). Similarly, the COPM assessment revealed clinically significant improvements (≥2-point change) in the performance of personal hygiene tasks, dressing, and cooking, as well as in satisfaction with performing personal hygiene, cooking, and driving tasks. The decrease in pain levels reported by the participants was also statistically significant with an average of 5,5 pre-test and 3,4 post-test on VAS (p<.001).

Conclusions. The comparative analysis of disability levels, pain levels, as well as performance of meaningful occupations before and after interventions indicates a significant improvement in functional independence and life satisfaction of military servicemen with amputations following an individualized occupational therapy program. Results presented in the paper demonstrate a positive correlation between COPM and DASH. The study indicates that occupational therapy services aimed at teaching compensatory strategies of task performance, environmental education and patient education are beneficial for clients with upper extremity amputations even without the use of prosthetic devices. Additionally, the results of the study support the effectiveness of occupational therapy for military servicemen.

References

American Occupational Therapy Association [AOTA]. (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(3), 7513410020. https://doi.org/10.5014/ajot.2021.75S3005

Atkins, D. J. (2016). Adult upper-limb prosthetic training. In D.J. Atkins & R.H. Meier, (Eds), Comprehensive management of the upper-limb amputee (pp. 39–59). Springer. https://doi.org/10.1007/978-1-4612-3530-9_6

Bassingthwaighte, L., Gustafsson, L., & Molineux, M. (2024). Lifespace and occupational participation following acquired brain injury during driving disruption: a mixed methods study. Disability and Rehabilitation, 47(1), 120–134. https://doi.org/10.1080/09638288.2024.2338192

Biddiss, E. A., & Chau, T. T. (2007). Upper limb prosthesis use and abandonment: a survey of the last 25 years. Prosthetics and orthotics international, 31(3), 236–257. https://doi.org/10.1080/03093640600994581

Burger, H., & Marincek, C. (2013). Driving ability following upper limb amputation. Prosthetics and orthotics international, 37(5), 391–395. https://doi.org/10.1177/0309364612473500

Classen, S., Monahan, M., Canonizado, M., & Winter, S. (2014). Utility of an occupational therapy driving intervention for a combat veteran. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 68(4), 405–411. https://doi.org/10.5014/ajot.2014.010041

Classen, S., Cormack, N. L., Winter, S. M., Monahan, M., Yarney, A., Lutz, A. L., & Platek, K. (2014). Efficacy of an occupational therapy driving intervention for returning combat veterans. OTJR : occupation, participation and health, 34(4), 177–182. https://doi.org/10.3928/15394492-20141006-01

Fitzgibbons, P., & Medvedev, G. (2015). Functional and clinical outcomes of upper extremity amputation. Journal of the American Academy of Orthopaedic Surgeons, 23(12), 751-60. https://doi.org/10.5435/JAAOS-D-14-00302

Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis care & research, 63 Suppl 11, S240–S252. https://doi.org/10.1002/acr.20543

Hermansson, L. N., & Turner, K. (2017). Occupational therapy for prosthetic rehabilitation in adults with acquired upper-limb loss: Body-powered and myoelectric control systems. Journal of Prosthetics and Orthotics, 29(4S), P45– P50. https://doi.org/10.1097/JPO.0000000000000154

Klarich, J., & Brueckner, I. (2014). Amputee rehabilitation and preprosthetic care: Amputee rehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 25(1). https://doi.org/10.1016/j.pmr.2013.09.005

Larsen, A. E., & Law, M. (2025). Canadian Occupational Performance Measure the state of the art – a review. Scandinavian Journal of Occupational Therapy, 32(1), 2473045. https://doi.org/10.1080/11038128.2025.2473045

List, E. B., Klieverik, V., Martin, E., Krijgh, D. D., & Henk Coert, J. (2025). Prevalence of residual limb pain and neuromas after upper extremity amputation: a systematic review and meta-analysis. The Journal of hand surgery, European volume, 17531934251345368. Advance online publication. https://doi.org/10.1177/17531934251345368

Miller, C. J., Shin, M., Pugatch, M., & Kim, B. (2021). Veteran Perspectives on Care Coordination Between Veterans Affairs and Community Providers: A Qualitative Analysis. The Journal of rural health: official journal of the American Rural Health Association and the National Rural Health Care Association, 37(2), 437–446. https://doi.org/10.1111/jrh.12526

Orr, A., Glover, J., & Cook, C. (2018). Amputations and prosthetics. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.; pp. 1083–1116). St. Louis: Elsevier.

Pyörny, J., Sletten, I. N., & Jokihaara, J. (2024). Concurrent validity study of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation. BMC musculoskeletal disorders, 25(1), 86. https://doi.org/10.1186/s12891-024-07183-w

Resnik, L., & Borgia, M. (2015). Reliability, Validity, and Responsiveness of the QuickDASH in Patients With Upper Limb Amputation. Archives of physical medicine and rehabilitation, 96(9), 1676–1683. https://doi.org/10.1016/j.apmr.2015.03.023

Smail, L. C., Neal, C., Wilkins, C., & Packham, T. L. (2020). Comfort and function remain key factors in upper limb prosthetic abandonment: findings of a scoping review. Disability and Rehabilitation: Assistive Technology, 16(8), 821–830. https://doi.org/10.1080/17483107.2020.1738567

Smurr, L.M, Gulick, K., Yancosek, K., & Ganz, O. (2008). Managing the upper extremity amputee: A protocol for success. Journal of Hand Therapy, 21(2), 160-176. https://doi.org/10.1197/j.jht.2007.09.006

Stark, S., Keglovits, M., Somerville, E., Hu, Y. L., Barker, A., Sykora, D., & Yan, Y. (2021). Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA network open, 4(8), e2122044. https://doi.org/10.1001/jamanetworkopen.2021.22044

Sugar, A. H., Ozelie, R., & Turner, K. (2024). The Occupational Therapy Practitioner Experience and Practice Related to Upper Limb Loss or Difference and Prosthetics. Journal of Occupational Therapy Education, 8 (2).https://doi.org/10.26681/jote.2024.080217

Swanson Johnson, S., & Mansfield, E. (2014). Prosthetic training: Upper limb. Physical Medicine and Rehabilitation Clinics of North America, 25(1), 133-151. https://doi.org/10.1016/j.pmr.2013.09.012