Physical health and performance of an ADVANCE subcohort of UK veteran traumatic lower limb amputees 12.5 years post-injury.

Authors

Jose M Frias-Bocanegra, Natalie Masters, Daniel T P Fong, Mark P Lewis, Alexander N Bennett, David J Williams, Sarah A Stapley

Published in

BMJ military health. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

During the Iraq and Afghanistan conflicts, survival following very severe injury increased. Now, more than 10 years since the cessation of hostilities, veterans are living with musculoskeletal (MSK) injury patterns not previously encountered. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study tracks the long-term physical and psychological outcomes of these veterans. This bolt-on study investigates the long-term physical effects of lower limb amputation.
In this cross-sectional study, 31 participants across three cohorts of injured military veterans-unilateral transtibial (UTT), unilateral transfemoral (UTF) and bilateral transfemoral (BiTF) amputees-undertook a functional assessment, including instrumentation and completion of a 6-min walk test (6MWT), synchronously recorded with a three-dimensional motion capture system, force plates and a wireless gas analysis mask to assess metabolic costs. In addition to the three injured cohorts, a group of age-matched controls was assessed for comparison.
The results of 41 participants across four groups, including matched controls, demonstrate a high degree of observed maintained fitness, with 6MWT distances covered being 595.8±99.7 m for UTT, 486.6±55.4 m for UTF, 481.7±122.9 m for BiTF and 662.7±80.9 m for controls. The metabolic costs of the BiTF and UTF cohorts were significantly higher than those of the UTT or control cohorts. Ground reaction forces (GRFs) during the gait cycle demonstrate early signs of asymmetry between intact and residual limbs in UTT and UTF groups. The BiTF cohort shows the fewest areas of asymmetry across the gait cycle. BiTF and UTF cohorts demonstrate significant GRF differences from those of the control group.
These results provide clinically relevant evidence for sustained functional preservation in veterans after major lower-limb trauma, substantiating the utility of the UK military's post-injury rehabilitation programme in terms of fitness and resilience essential for enduring high function. It also provides some early indications of developing asymmetries within the gait cycle that should be monitored and studied as possible evidence of early MSK disease.

PMID:
42772809
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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