University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Orthopaedic Surgery


Nancy E. Reid, MHA, DHSc, PA-C


  • The objective of this article is to review literature and determine the best treatment option of the mangled lower extremity at time of presentation with primary amputation versus limb reconstruction based on patient reported outcomes (PRO).
  • Numerous literature with evidence-based research demonstrates the use of PRO to determine the best treatment outcomes of the mangled lower extremity in orthopaedic trauma with no agreement whether amputation or reconstruction is a better treatment option. Further studies may be needed to determine the injury burden based on PRO so that appropriate treatment guidelines can be developed.
  • The Patient-Reported Outcomes Measurement Information System (PROMIS) allows the development of numerous domains to capture a wide range of information more efficiently with less burden on the patient and the provider when compared to legacy measurements alone. PROMIS may play a key role in future research to improve patient-centered care for the mangled extremity.
  • A collaborative patient-provider discussion with implementation of patient-centered care should be used to provide the best functional outcome by obtaining knowledge of the patient’s expectations during treatment, recovery, and health related quality of life after severe trauma. A patient-centered approach and treatment plan with a multidisciplinary team that incorporates plastics, psychology, pain management and rehabilitation (PM&R), and prosthetics will advance research in orthopaedic trauma patients to derive predictive models.


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