Return to duty after integrated orthotic and rehabilitation initiative

OBJECTIVES:: To determine the return to active duty rate of military service members undergoing lower extremity limb salvage while using a novel custom orthosis and specialized rehabilitation compared with those receiving a novel custom orthosis alone. DESIGN:: Retrospective cohort study. SETTING:: Military level I trauma center and tertiary referral center for limb salvage. PATIENTS/PARTICIPANTS:: All active duty service members enrolled in our institution's Return to Run Clinical Pathway were analyzed retrospectively. Service members were enrolled if they sustained injuries with residual disability below the knee. Injuries typically involved substantial motor and/or nerve deficit, and the overwhelming majority was secondary to high-energy injuries. INTERVENTION:: Service members were fitted with a customized orthosis, an Intrepid Dynamic Exoskeletal Orthosis (IDEO), for use during rehabilitation. Service members were divided into 2 groups: those who had participated in the Return to Run Clinical Pathway with an IDEO (group 1) and those who only were fitted with an IDEO only (group 2). MAIN OUTCOME MEASURE:: Return to military active duty rate. RESULTS:: One hundred forty-six service members met the inclusion criteria. Group 1 consisted of 115 service members and group 2 consisted of 31 service members. Of those in group 1, 59 (51.3%) returned to active duty compared with 4 (12.9%) in group 2 (P = 0.0001). Mechanisms of injury were significant factors for return to duty (RTD), and those sustaining explosive mechanisms of injury or gunshot wounds had significantly lower RTD rates across both groups. CONCLUSIONS:: Active duty service members participating in an integrated orthotic and rehabilitation initiative after a lower extremity injury have a higher rate of RTD than previous reports, and it is significantly higher than the orthotic device alone.