Improving Acceptability and Outcomes for Upper Extremity Transplantation in Service Members and Veterans

Specific Aim 1: To identify psychosocial factors related to the acceptability and barriers to upper extremity transplantation from Service members and/or Veterans with upper extremity amputations. Specific Aim 2: To identify psychosocial factors related to the acceptability and barriers to upper extremity transplantation and recovery in Service members and/or Veterans who underwent UE transplantation. Specific Aim 3: To quantify the value and benefits Service member and/or Veteran UE amputees attribute to UE transplantation. Study Design: Specific Aim 1. We will use a modified Delphi iterative design to conduct a series of interviews with Service members and/or Veterans who are unilateral or bilateral UE amputees to determine factors pertaining to UE transplantation. Interviews will be reviewed and themes coded and compiled into a list to be redistributed to the Service member and/or Veteran interviewees to confirm comprehensiveness. The final list of themes will be distributed for participant ranking. The ranking process will be performed up to three times to determine the most important themes to Service members/Veterans. Specific Aim 2.We will conduct semi-structured interviews using the constant comparative method. This will be followed by rigorous coding using open and axial coding and an organizational scheme, making it possible to determine saturation and identify prominent psychosocial factors. This approach is appropriate for the Veteran and Service member UE transplant population for whom few patient-reported factors are known and it may be difficult to otherwise reflect patients’ true reality. Specific Aim 3. We will conduct discrete choice experiments (DCEs) to assess individual preferences between two or more hypothetical health scenarios or treatment choices. Through the systematic construction of choice sets and analysis of the respondents’ choices, we will assess the relative importance of individual health attributes and acceptable trade-offs persons with UE limb loss must choose between: no action, prosthetics, or transplantation. Impact and Military Relevance: This study has the ability to be the first published survey of Service member/ Veteran UE amputees on key factors regarding acceptability/barriers to and valuation of UE transplantation. This information is vital to determine the utility of UE transplantation for unilateral and bilateral amputees in this population, better identify patients who will most benefit from reconstructive transplantation, and better address psychosocial barriers that may otherwise prevent Service Members and Veterans from being candidates