Management of Upper Limb Amputation Rehabilitation (ULA)

Publication Date: April 26, 2022
Last Updated: May 2, 2022

Surgery/Pre-prosthetic

There is insufficient evidence to assess the impact of the level of amputation or amputation surgical procedure type on functional status and prosthesis-related outcomes. (Neither for or against)
315659
For patients undergoing upper limb amputation surgery, there is insufficient evidence to recommend the use of any particular factors to predict the speed and quality of wound healing, successful prosthesis fitting, or need for revision surgery. (Neither for or against)
315659
There is insufficient evidence to recommend for or against the use of any particular recent treatment advances including hardware, software, surgical, technology, or supplemental surgical interventions, such as:
  • targeted muscle reinnervation (TMR)
  • regenerative peripheral nerve interfaces (RPNI)
  • vascularized composite allotransplantation (VCA)
  • agonist-antagonist myoneural interface (AMI)
  • implantable myoelectric sensor system (IMES)
  • osseointegration (OI)
(Neither for or against)
315659

Rehabilitation

There is insufficient evidence to recommend for or against any particular training protocol to improve function and outcomes. (Neither for or against)
315659
We suggest the use of mirror therapy for the short-term reduction of phantom limb pain. (Weak for)
315659
There is insufficient evidence to recommend for or against any particular treatment setting, intensity, or service delivery model. (Neither for or against)
315659

Prosthetic Restoration

For patients with major unilateral upper limb amputation (i.e., through or proximal to the wrist), we suggest use of a body-powered or externally powered prosthesis to improve independence and reduce disability. (Weak for)
315659
There is insufficient evidence to recommend for or against any specific control strategy, socket design, suspension method, or component. (Neither for or against)
315659

Medical

There is insufficient evidence to recommend for or against a particular intervention for the prevention of phantom and/or residual limb pain. (Neither for or against)
315659
There is insufficient evidence to recommend for or against any particular pharmacologic intervention for the management of phantom and/or residual limb pain. (Neither for or against)
315659
There is insufficient evidence to recommend for or against the use of non-invasive brain stimulation for the management of phantom limb pain. (Neither for or against)
315659

Outcomes

There is insufficient evidence to recommend for or against the use of any specific assessment tool to guide the determination of prosthetic candidacy, the need for therapy, or for identifying improvement or worsening of function and quality of life. (Neither for or against)
315659

Psychosocial Considerations

We suggest screening patients for cognition, mental health conditions such as posttraumatic stress disorder and depression, and pain during the initial evaluation and across the continuum of care. (Weak for)
315659
We suggest offering peer support services. (Weak for)
315659

Recommendation Grading

Overview

Title

Management of Upper Limb Amputation Rehabilitation (ULA)

Authoring Organization

Publication Month/Year

April 26, 2022

Last Updated Month/Year

February 12, 2024

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Long term care, Outpatient

Intended Users

Occupational therapist, physical therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Rehabilitation

Diseases/Conditions (MeSH)

D012046 - Rehabilitation, D000671 - Amputation, D010810 - Physical and Rehabilitation Medicine

Keywords

rehabilitation, limb amputation

Source Citation

Crunkhorn A, Andrews E, Fantini C, Highsmith MJ, Loftsgaarden M, Randolph B, Sall J, Webster J. The Management of Upper Limb Amputation Rehabilitation: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for Acquired Amputation. Am J Phys Med Rehabil. 2022 Dec 8. doi: 10.1097/PHM.0000000000002164. Epub ahead of print. PMID: 36480336.