Upper Extremity Amputation Rehabilitation

Publication Date: January 1, 2014


All recommendatiions are graded "Expert Opinion" except #11.

The Care Team Approach

An interdisciplinary amputation care team (care team) approach, including the patient, family and/or caregiver(s), is recommended in the management of all patients with upper extremity amputation.
Care teams should communicate on a regular basis to facilitate integration of a comprehensive treatment plan.

Comprehensive Interdisciplinary Assessments

Comprehensive interdisciplinary assessments and reassessments should be completed during each of the first three phases of care (perioperative, pre-prosthetic and prosthetic training).
Annual comprehensive interdisciplinary screening should be conducted for all patients with an upper extremity amputation throughout lifelong care.
Functional status measures should be utilized during assessments and reassessments throughout all phases of care to document outcomes and monitor the efficacy of rehabilitation.

Patient-Centered Care

A shared decision making model, incorporating patient goals, should be used throughout all phases of rehabilitation to ensure patient-centered care.
A comprehensive, interdisciplinary, patient-centered rehabilitation plan should be developed as early as possible and updated throughout all phases of care based on patient’s progress, changes in functional status, emerging needs, and goals.
Patient-centered physical and functional rehabilitation interventions should be initiated based on the rehabilitation plan and the patient’s physical and psychological status.
Various types of pain following upper limb loss should be managed appropriately and individually throughout all phases using pharmacological and non-pharmacological treatment options.
The care team should provide appropriate education and informational resources to patients, family and caregiver(s) throughout all phases of care.
The care team should facilitate early involvement of a trained peer visitor.
(There is at least moderate certainty that the net benefit is small. Offer or provide this service for selected patients depending on individual circumstances.)

Perioperative Phase

The decision for amputation should be made based upon accepted surgical and medical standards of care.
Communication must occur between the surgical and non-surgical members of the care team in order to optimize surgical and functional outcomes.
The care team should ensure that the patient is optimized for rehabilitation to enhance functional outcomes.
Following amputation, the care team should ensure that the patient has achieved his or her highest level of functional independence without a prosthesis.

Pre-Prosthetic Phase

The care team should ensure that patients undergo pre-prosthetic training to help determine the most appropriate type of device to achieve functional goals.
Once the appropriate type of prosthesis is identified, the care team should write a prosthetic prescription including all necessary components.
Initiate upper extremity prosthetic fitting as soon as the patient can tolerate mild pressure on the residual limb.

Prosthetic Training Phase

Upon delivery of the prescribed prosthesis, or change in the control scheme or componentry, the care team must engage the patient in prosthetic training and education.
The care team should frequently reassess the patient’s prosthetic fit and function throughout the prosthetic training phase and modify as appropriate.
The final check out of the prosthesis should take place with appropriate members of the care team to verify that the prosthesis is acceptable.
The care team should offer active prosthesis users at least one back up device to ensure consistency with function.
Prescription of activity specific or alternate design prostheses may be considered, dependent upon the patient’s demonstration of commitment, motivation, and goals.

Lifelong Care

Upon completion of functional training, and to ensure continuity, the care team should coordinate patient transition into the lifelong care phase.
The care team should provide routine, scheduled follow-up contact for patients with upper extremity amputation at a minimum of every 12 months, regardless of prosthetic use or non-use.
Upon notification of patient relocation to a new catchment area, the care team should communicate with the receiving care team and coordinate transition of patient care.
The care team should provide education to the patient, family, and caregiver(s) regarding advancements in technology, surgical, and rehabilitation procedures related to the management of upper extremity amputation.

Recommendation Grading




Management of Upper Extremity Amputation Rehabilitation

Authoring Organization

Endorsing Organization

Publication Month/Year

January 1, 2014

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Long term care, Medical transportation, Operating and recovery room

Intended Users

Social worker, psychologist, physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant


Counseling, Assessment and screening, Rehabilitation, Management, Treatment

Diseases/Conditions (MeSH)

D000671 - Amputation, D034941 - Upper Extremity


amputation, rehabilitation, Upper Extremity, Pre-Prosthetic Training, Prosthetic fitting

Supplemental Methodology Resources

Methodology Supplement


Number of Source Documents
Literature Search Start Date
January 1, 2002
Literature Search End Date
June 1, 2013