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INTRODUCTION: A comprehensive study to assess quality and outcomes of care for Veterans with upper limb amputation is needed. This paper presents methods and summary findings from a national survey of Veterans with upper limb amputation. METHODS: After completion of a pilot study to develop and refine methods, computer-assisted telephone interviews were conducted with 808 Veterans with upper limb amputation (response rate = 47.7%; cooperation rate = 63.3%). RESULTS: Respondents were 776 unilateral and 32 bilateral amputees, 97.5% male, mean age 63.3 (sd 14.1). Prostheses were used by 60% unilateral and 91% bilateral, the majority used body powered devices. Prostheses were used > /=8 hours/day by 52% unilateral and 76% bilateral. Prosthetic training was received by 71% unilateral and 59% bilateral. Mean prosthetic satisfaction was 3.9 (sd 0.6) and 3.8 (sd 0.7) as measured by TAPES; and 25.0 (sd 5.1) and 25.7 (sd 4.5) as measured by OPUS CSD for unilateral and bilateral respectively. Mean perceived disability (measured by QuickDASH) scores were 49.5 (sd 20.7) for unilateral and 34.7 (sd 22.0) for bilateral. VR-12 PCS scores were below population norms. The majority reported contralateral limb pain, musculoskeletal conditions, back and neck pain. Phantom limb pain was reported in 83.4% of unilateral and 68.8% of bilateral, and residual limb pain in 65.1% of unilateral and 68.8% of bilateral. Most, (81.8% unilateral, 84.4% bilateral) had been to a Veterans Affairs medical center (VA) for amputation care, while 57% of unilateral and 81.3% of bilateral had been to a VA amputation clinic. DISCUSSION/CONCLUSION: Veterans with upper limb amputation have moderately impaired physical functioning. Prosthesis use rates were lower than previously reported. Although satisfied with their prostheses, nearly half used them < /=8 hours/day. Rates of musculoskeletal problems, phantom and residual limb pain were higher than previously reported. A substantial proportion never received prosthetic training, or VA amputation care.

INTRODUCTION: Osseointegrated (OI) prostheses have a unique benefit-risk profile among prosthetic alternatives and have been marketed in the United States under a Humanitarian Device Exemption since 2015. Information about upper limb prosthesis user perspectives on benefits and risks, prosthesis-user subpopulations for whom OI is most acceptable, and outcomes that matter most to patients could help inform clinical and regulatory decision-making. Recent 21st Century Cures legislation expanded the role of patient experience data in the decision-making process of the U.S. Food and Drug Administration, recognizing that patient perspectives may be informative to regulators. OBJECTIVE: To better understand prosthesis user perspectives about the benefits and risks associated with upper limb OI prostheses. DESIGN: Patient perspective survey. SETTING: Telephone administration. PARTICIPANTS: National sample of veterans with upper limb loss. INTERVENTIONS: NA MAIN OUTCOME MEASURES: Benefit-risk survey developed for this study. RESULTS: Twenty-eight percent of unilateral and 13% of bilateral amputees were willing to consider osseointegration surgery. Multivariate logistic regression models [OR; 95% CI] showed that transhumeral amputation level [OR 1.40; 1.01-1.98] was associated with greater willingness to consider surgery, whereas older age [OR 0.17; 0.09-0.32] and higher VR-12 Mental Component Summary [OR 0.53; 0.35-0.81] were associated with less willingness. Having a durable/reliable device, the ability to do more activities, and having a comfortable device were rated as very important or somewhat important by 98% or more for every risk condition. CONCLUSIONS: Persons who were older, had transradial amputation (compared to transhumeral), and those who had better mental functioning were less willing to consider this surgery. Respondents who were willing to consider surgery indicated that the most important potential benefits were obtaining a durable/reliable device, the ability to do more activities, and having a comfortable device. Most were willing to accept one or more risks of surgery, with long-term risks including chronic pain, loss of nerve function, or device failure considered the most unacceptable. LEVEL OF EVIDENCE: III. has been contributed to by US Government employees and their work is in the public domain in the USA.