Prosthetics and Orthotics International最新文献

{"title":"Gender differences in physical and psychological outcomes after lower limb amputation in Iran: A comparative and mediation analysis study.","authors":"Fateme Eskandarighargheh, Taher Babaee, Masoomeh Nakhaee, Sheila Clemens, Szu-Ping Lee","doi":"10.1097/PXR.0000000000000559","DOIUrl":"https://doi.org/10.1097/PXR.0000000000000559","url":null,"abstract":"<p><strong>Background and objective: </strong>This study investigates gender differences in mobility, quality of life (QoL), and self-esteem among individuals with unilateral lower limb amputation in Iran, with a focus on mediating roles of education, self-esteem, and time since amputation.</p><p><strong>Study design: </strong>In this cross-sectional study, 100 participants (52 women, 48 men) completed validated measures assessing locomotor function locomotion capability index, QoL (12-item short form survey), and self-esteem (Rosenberg Self-Esteem Scale).</p><p><strong>Result: </strong>The sample consisted of 100 individuals (52 women, 48 men) with 44 ± 16 mean age for women and 45 ± 15 years for men. Mean years of education was 9.36 years an average duration of 13.32 years since amputation. Regarding the level of amputation, most participants had below-knee amputations (61%), followed by above-knee (21%), knee (11%), ankle (5%), and hip (2%) amputations. The primary causes of amputation were trauma (57%). Although no significant gender differences were found in mobility or overall QoL, women reported significantly lower self-esteem than men. Higher education levels were linked to enhanced self-esteem and better QoL. Mediation analyses revealed that gender influenced QoL indirectly through self-esteem, education, and time since amputation. Specifically, self-esteem was a key mediator linking gender to mental health outcomes, with women's lower self-esteem associated with reduced QoL.</p><p><strong>Conclusion: </strong>These findings suggest that cultural and societal factors in Iran may disparately affect women's psychological adjustment to amputation. The study highlights the importance of gender-sensitive rehabilitation strategies that address self-esteem and other aspects of psychosocial well-being for women with amputation in Iran.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods for measuring the sagittal resistive torque of ankle-foot orthoses during gait: A systematic review.","authors":"Ole Strenge, David Hochmann","doi":"10.1097/PXR.0000000000000565","DOIUrl":"https://doi.org/10.1097/PXR.0000000000000565","url":null,"abstract":"<p><p>The measurement of resistive torque exerted by passive ankle-foot orthoses during walking plays a critical role in understanding their biomechanical effects and in optimizing their functionality. This systematic review investigates existing measurement methods to evaluate how orthotic torque is quantified during gait, offering insights into currently used methods and technologies. Because many methods are closely linked to the use of test benches, these methods are also discussed but are not the scope of this work. A comprehensive systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, encompassing databases such as PubMed, Scopus, Web of Science, and IEEE Xplore, and AI-assisted literature search tools. The selected keywords focus on passive ankle-foot orthoses, in-gait measurement, and torque-related outcomes. From an initial pool of 2237 articles, a systematic exclusion refined the selection to 30 relevant studies. These were categorized into 3 groups: indirect measurement methods using gait analysis, indirect measurement methods using instrumented orthoses, and direct measurement methods. The results highlight a lack of standardized methods for quantifying orthotic torque and for quantifying the properties of ankle-foot orthoses themselves. Many studies fail to detail their measurement techniques thoroughly. Although indirect methods dominate, they may lack measurement accuracy. Direct measurement methods appear to be more accurate but exhibit individual limitations. This review emphasizes the necessity for reliable measurement techniques to advance clinical practices and research. Addressing these gaps has the potential to enhance the design, functionality, and prescription of ankle-foot orthoses for improved patient care.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individuals with a trans-tibial amputation present trunk and lower limbs biomechanical asymmetry during sit-to-stand transitions.","authors":"Alexandre Thibault-Piedboeuf, Simon Laurendeau, Ludovic Miramand, Gabriel Moisan, Katia Turcot","doi":"10.1097/PXR.0000000000000563","DOIUrl":"10.1097/PXR.0000000000000563","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with a transtibial amputation (iTTA) are usually fitted with a prosthetic leg. However, it does not prevent functional limitations or compensatory strategies during daily activities, such as sit-to-stand transition (STS). Compensatory strategies may be linked to higher risk of secondary joint conditions.</p><p><strong>Objective: </strong>This study aimed to assess compensatory strategies using kinetic asymmetry and trunk kinematics among iTTA compared with healthy counterparts during STS.</p><p><strong>Methods: </strong>Nine iTTA and 9 healthy subjects performed 5 STS. Kinematic and kinetic data were recorded using a motion capture system, an instrumented chair, and floor-embedded force platforms. Total support moment (TSM), joint contribution to the TSM, vertical ground reaction forces (vGRF), and trunk kinematics were assessed. The TSM was calculated during each STS phase (leaning, momentum, and extension). One-way ANOVA and Games-Howell post-hoc test were used to compare limb contribution. Between-limb symmetry index (SI), for TSM joint contribution and vGRF, and trunk kinematics were compared between groups using an independent Student t-test.</p><p><strong>Results: </strong>During the STS, higher TSM was found in the intact lower limb of iTTA compared with their amputated limb and healthy subjects' dominant limb. Compared with healthy subjects, showing symmetrical TSM joint contribution, iTTA demonstrated higher asymmetries at each lower limb joint, along with higher vGRF asymmetry and trunk range of motion. Momentum and extension phases generated significant asymmetries at the knee between limbs of iTTA (p < 0.05).</p><p><strong>Conclusion: </strong>Results support that iTTA rise from a chair with high joint asymmetry that might lead to disproportionate worn out of joints and secondary issues.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does lower limb amputation affect lateralization and motor imagery ability in prosthesis users and nonusers? A cross-sectional, assessor-blinded study.","authors":"Şüheda Özkan, Sultan Yekelenga Özen","doi":"10.1097/PXR.0000000000000575","DOIUrl":"10.1097/PXR.0000000000000575","url":null,"abstract":"<p><strong>Background: </strong>Amputation leads not only to limb loss but also to alterations in body representation, motor planning, and sensorimotor integration. Prosthesis use may help preserve these representations; however, its influence on cognitive motor processes such as laterality judgment and motor imagery remains unclear.</p><p><strong>Objectives: </strong>This study aimed to examine the effects of lower limb amputation (LLA) and prosthesis use on laterality judgment performance and motor imagery ability compared with able-bodied individuals.</p><p><strong>Methods: </strong>Three groups participated: prosthesis users (PU) and nonprosthesis users (N-PU) with acquired unilateral LLA at or above the below-knee level, and normally limbed controls. Participants completed a laterality judgment task (reaction time and accuracy), the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2), and the imagined Timed Up and Go (iTUG) test. Repeated measures ANOVAs, one-way ANOVAs, and independent samples t-test were conducted to analyze group differences.</p><p><strong>Results: </strong>In the laterality task, N-PU participants demonstrated significantly longer reaction times than controls in the abstract condition for both the nonamputated (p = 0.001) and amputated sides (p = 0.004), along with lower overall accuracy (p = 0.035), whereas PU participants performed comparably with controls (p > 0.05). In the VMIQ-2, both amputee groups showed significantly reduced imagery vividness across all subscales compared with controls (p < 0.05); however, PU participants exhibited significantly greater kinesthetic imagery vividness than N-PU participants (p = 0.001). No significant difference was found between PU and controls in iTUG performance (p = 0.051).</p><p><strong>Conclusions: </strong>Prosthesis use appears to support the preservation of motor imagery ability and spatial representation in individuals with LLA. These findings emphasize the potential cognitive-motor benefits of prosthetic integration and support the inclusion of imagery-based assessments in rehabilitation programs.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical assessment of persons with bilateral transfemoral/through-knee amputations using stubby prostheses: A pilot study.","authors":"Diana Toderita, David P Henson, Clement D Favier, Vasiliki Vardakastani, Kate Sherman, Biranavan Sivapuratharasu, Alison H McGregor, Anthony M J Bull","doi":"10.1097/PXR.0000000000000562","DOIUrl":"10.1097/PXR.0000000000000562","url":null,"abstract":"<p><strong>Background: </strong>Stubby prostheses are nonarticulated prostheses used by persons with bilateral transfemoral/through-knee amputations (BTF) either exclusively or alongside full-length articulated prostheses. The implications of stubby prosthesis use on musculoskeletal function and movement patterns are unclear. This study aims to provide insights into the biomechanics of walking with stubbies.</p><p><strong>Methods: </strong>Gait data were collected using a 10-camera motion capture system from 4 male traumatic BTF who exclusively use stubbies and 4 male traumatic BTF who use multiple prostheses, including stubbies and full-length articulated prostheses. Both cohorts completed level-ground walking trials wearing stubby prostheses. Muscle parameters were quantified through high-resolution magnetic resonance imaging scans.</p><p><strong>Results: </strong>Compared with BTF who use multiple prostheses, stubbies-only users showed lower walking speeds by 15% (0.79 vs 0.93 m/s), lower cadence by 20% (91.2 vs 114.7 steps/min), lower peak hip flexion angles by 45% (19.7° vs 35.9°), and larger peak-to-peak anterior pelvic tilt by 103% (15.8° vs 7.8°). Stubbies-only users presented lower overall muscle volume and physiological cross-sectional area.</p><p><strong>Conclusion: </strong>In this small cohort, full-time stubby users presented signs of muscle weakness that were not observed in those using full-length articulated prostheses. This may affect current and future functional abilities.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinetic asymmetry in unilateral transfemoral amputees: Gait biomechanics and reliability assessments.","authors":"Tsung-Yeh Chou, Kristin Reeves, Danielle Melton, David Doherty, Payam Zandiyeh","doi":"10.1097/PXR.0000000000000572","DOIUrl":"10.1097/PXR.0000000000000572","url":null,"abstract":"<p><strong>Background: </strong>Individuals with unilateral transfemoral amputation (TFA) commonly experience gait-related loading asymmetries, elevating their risks of lower limb injuries and degenerative changes. To evaluate the effects of interventions on these asymmetries, it is crucial to assess test-retest reliability and establish minimum detectable changes (MDCs) for loading-related measures. Determining them for these measures would help distinguish meaningful interventional effects from daily variability. This study evaluated test-retest reliability and established MDC values for ground reaction force (GRF) during treadmill walking in individuals with TFA and compared GRF outcomes between the amputated and intact limbs.</p><p><strong>Methods: </strong>Ten participants underwent 2 study visits, 1 month apart. Ground reaction force data were collected during treadmill walking at a self-selected speed. Outcome measures included loading rates, unloading rates, braking impulses, and propulsive impulses, normalized by body weight. Intersession reliability and MDC values were computed with intraclass correlation analysis. Side-to-side differences were analyzed using repeated-measures ANOVAs. Ground reaction force time series were compared using statistical parametric mapping (SPM-1d).</p><p><strong>Results: </strong>Braking and propulsion impulses demonstrated good-to-excellent reliability (intraclass correlation coefficients >0.82) in both limbs, whereas intact limb loading rates showed poor reliability. Higher loading rate but lower propulsion impulses were detected in the amputated limb, with differences in propulsion impulses exceeding MDC values. SPM-1d analyses detected side-to-side differences in GRF waveforms at the beginning and the end of the stance phase in superior-inferior and anterior-posterior directions.</p><p><strong>Conclusion: </strong>Impulse outcomes are reliable measures, promising for future investigation of treatment effectiveness in longitudinal gait studies in individuals with TFA.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The perceptions and experiences of ankle-foot orthosis use among youth with cerebral palsy and their parents: A qualitative study with focus on activity and participation.","authors":"Jessica Stockman, Ann Alriksson-Schmidt, Eva Jason-Åndell, Ira Jeglinsky-Kankainen","doi":"10.1097/PXR.0000000000000566","DOIUrl":"10.1097/PXR.0000000000000566","url":null,"abstract":"<p><strong>Introduction: </strong>Ankle-foot orthosis (AFO) is the most common orthotic device for children with cerebral palsy (CP), improving stride length, walking speed, and stability. Although AFO use is highest in children ages 6-12 years, it often decreases with age, and little is known about how youth and parents perceive AFO use in daily life, particularly regarding activity and participation.</p><p><strong>Aim: </strong>To explore the perceptions and experiences of AFO use in daily life among youth with CP and their parents, with a focus on activity and participation.</p><p><strong>Method: </strong>This qualitative study included 18 interviews with 9 AFO users with CP (8-15 years) and their parents. Data were analyzed using a descriptive phenomenological approach.</p><p><strong>Results: </strong>Four closely related themes emerged. The first, \"AFO use evokes emotions and feelings,\" captured positive and negative emotional responses to wearing AFOs. The second, \"AFO use requires adaptation in everyday life,\" described practical adjustments needed to integrate AFOs into daily routines. The third, \"Experience creates awareness of autonomy and usefulness,\" reflected how youth and parents gradually develop focused knowledge of when and how AFOs support daily functioning. Finally, \"Participation in the AFO provision process\" highlighted the role of communication and collaboration between families and professionals.</p><p><strong>Conclusion: </strong>AFO use in youth with CP involves complex emotional, practical, and participatory dimensions. Active inclusion of families through collaborative goal-setting from the outset of the orthotic process, and throughout follow-up, alongside consideration of emotional and social factors, can optimize orthotic outcomes and psychosocial well-being.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Existing methodologies for triaging referrals in orthotic services and wider allied health professional settings: A scoping review.","authors":"Matthew Wood","doi":"10.1097/PXR.0000000000000576","DOIUrl":"10.1097/PXR.0000000000000576","url":null,"abstract":"<p><p>This scoping review aims to establish an understanding of existing tools or methodologies to grade referral quality or appropriateness published in an orthotics, Allied Health Profession (AHP), or AHP-involved setting. All patients deserve equal access to NHS services, but without knowing if services accept and triage referrals in the same way, it is not possible to. The PRISMA (ScR) checklist was used to structure this scoping review. The search was performed on March 04th, 2025, and was restricted to publications in the English Language only. Publications were screened and extracted by a single reviewer. Further to the literature search a call for gray literature, unpublished service evaluations, or audits through the British Association of Prosthetists and Orthotists, 71 publications were found, and 19 of these were included in the review. No publications focused on an orthotics setting, and only 3 publications centered on AHP specific services. Large variations exist in the methodology used and the purpose of evaluating referrals, with the 2 key tests of appropriateness appearing to be clinicians' judgment or on the outcome after a referral. There is a gap that appears to exist wider than the orthotics profession in what is considered an appropriate referral and an agreed upon methodology for measuring appropriateness. This could be a valuable topic for further research and consideration, with the initial steps being to establish an understanding of how orthotic departments receive and evaluate referrals and understanding if there are differences in experience or common problems that services face.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empathy to exhaustion: A mixed-methods qualitative study exploring burnout in orthotic and prosthetic clinicians.","authors":"Delaney Schavey, Jeremy Sherman","doi":"10.1097/PXR.0000000000000573","DOIUrl":"https://doi.org/10.1097/PXR.0000000000000573","url":null,"abstract":"<p><strong>Background: </strong>Burnout is a phenomenon that has been extensively documented across health care professions, but empirical investigation within orthotics and prosthetics (O&P) remains limited. This leaves a critical gap in understanding clinician well-being in a field defined by distinct clinical, technical, and organizational demands.</p><p><strong>Objective: </strong>This study aimed to quantify burnout levels in O&P clinicians and explore the factors contributing to this phenomenon.</p><p><strong>Study design: </strong>This study used a convergent parallel mixed-methods approach: a survey incorporating the Abbreviated Maslach Burnout Inventory (aMBI) to gather burnout incidence, and semi-structured interviews to assess burnout experiences, personal and professional factors, and possible prevention strategies among orthotics and prosthetics clinicians.</p><p><strong>Methods: </strong>Participants first completed a survey incorporating the aMBI to assess burnout incidence as it correlates to the 3 domains of burnout-emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Survey participants could then elect to participate in semi-structured interviews for qualitative insight and thematic analysis. Data were analyzed for correlations between survey responses and personal factors gathered from the interviews.</p><p><strong>Results: </strong>Approximately 78.3% of respondents experienced burnout in at least 1 domain, with emotional exhaustion being the most prevalent. Men experienced higher rates of depersonalization than women. From the semi-structured interviews, four overarching themes emerged: organizational and workload pressures, financial and career strain, individual coping and protective strategies, and burnout experience and trajectory.</p><p><strong>Conclusions: </strong>Burnout was highly prevalent among O&P clinicians, with emotional exhaustion representing the most prominent domain. Qualitative findings highlighted the contribution of organizational or workload pressures, financial and career strain, coping strategies, and the progressive nature of burnout. These results underscore burnout as a multidimensional phenomenon influenced by both individual and systemic factors, and further research into interventions addressing this issue is critical for clinician well-being and the sustainability of the profession.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency stipend study to modernize and increase competitiveness in VA's ability to recruit, train, and retain top future orthotists and prosthetists: A collaborative analysis between the VA Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS) program office and the VA Prosthetics & Orthotics Residency (VAPOR) program.","authors":"Michael K Carroll, Martin L McDowell, Christopher M Fantini, Jeffrey Bott, Chris Robinson, M Jason Highsmith","doi":"10.1097/PXR.0000000000000579","DOIUrl":"https://doi.org/10.1097/PXR.0000000000000579","url":null,"abstract":"<p><strong>Introduction: </strong>In the 2022/2023 training cycle, the VA Prosthetic Orthotic Residency (VAPOR) Program was unable to fill all funded residency positions. Initial debriefing with residency directors revealed a likely cause to be lack of competitiveness of the VAPOR training stipend value, particularly for second-year residents. This demonstrated a need to conduct a training stipend analysis for the VAPOR program.</p><p><strong>Methods: </strong>A five-part analysis was conducted including review of the program's stipend history, review of the impact of inflation, and surveys of residency directors and current and former residents.</p><p><strong>Results: </strong>Cumulatively, the analysis revealed that the current stipend was no longer competitive and that the profession was compensating second-year residents more than first-year residents. To effectively compete for top residency candidates, the VA must increase the current training stipend. Ultimately, 4 evidence-based recommendations were derived from the analysis as follows: (1) VAPOR Year 2 (Y2) stipends should be greater than the Year 1 (Y1) stipends; (2) VAPOR Y1 residents should receive a base stipend of $41,620 in addition to a locality adjustment based on the site location; and (3) VAPOR Y2 residents should receive a nonadjusted base stipend valued at 9.3% more than the Y1 stipend or $45,491 to be increased with a locality adjustment based on the site location.</p><p><strong>Conclusions: </strong>A cost-of-living adjustment should be applied to VAPOR program stipends at a minimum of every 3 to 5 years at an increase of 3-5% based on cost-of-living data from other government resources. VA bolstered resident compensation because of these findings.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}