USU Helps Shapes the Future of Amputee Care with Updated Clinical Practice Guidelines

USU’s Department of Physical Medicine and Rehabilitation advances rehabilitation, enhances recovery, and supports military readiness through the 2025 Clinical Practice Guidelines

U.S. Air Force Staff Sgt. Sebastiana Lopez Arellano, a patient at Walter Reed National Military Medical Center, pulls a weighted sled around a track inside the center’s Military Advanced Training Center. For patients like Arellano, research-based guidelines for clinicians are vital in their treatment. The updated Clinical Practice Guideline on the Rehabilitation of Individuals with Lower Limb Amputation, a collaboration between the Department of Veterans Affairs and Department of Defense with oversight through the Defense Health Agency’s Office of Evidence Based Practice, was released in January 2025, and offers important evidence-based research and recommendations for care and treatment of patients with lower limb loss. (Photo by: Sean Kimmons)
U.S. Air Force Staff Sgt. Sebastiana Lopez Arellano, a patient at Walter Reed National Military Medical
Center, pulls a weighted sled around a track inside the center’s Military Advanced Training Center. For
patients like Arellano, research-based guidelines for clinicians are vital in their treatment. The updated
Clinical Practice Guideline on the Rehabilitation of Individuals with Lower Limb Amputation, a
collaboration between the Department of Veterans Affairs and Department of Defense with oversight
through the Defense Health Agency’s Office of Evidence Based Practice, was released in January 2025,
and offers important evidence-based research and recommendations for care and treatment of patients
with lower limb loss. (Photo by: Sean Kimmons)

March 12, 2025 by Sharon Holland

The Uniformed Services University (USU) is at the forefront of advancing care for service members and veterans with limb loss, and its role in shaping the newly released 2025 Clinical Practice Guidelines (CPG) on the Rehabilitation of Individuals with Lower Limb Amputation (LLA) is a testament to that commitment. Developed in partnership with the Department of Veterans Affairs (VA) under the oversight of the Defense Health Agency, these guidelines integrate the latest research to improve patient outcomes, enhance rehabilitation strategies, and support military readiness.

For Dr. Tawnee Sparling, medical director for Amputee Care and assistant professor in USU’s Department of Physical Medicine and Rehabilitation (PM&R), these updates are an essential step forward. “Our service members deserve world-class rehabilitation and treatment. This updated CPG is a crucial tool that will directly impact recovery, rehabilitation, and the ability to return to duty.”

The 2025 update builds on the 2017 version, incorporating advances in surgical procedures, behavioral health, pain management, and rehabilitation techniques. The field of amputee care is constantly evolving, and ensuring clinicians have access to the most current, evidence-based strategies is vital to delivering top-tier care.

One of the most significant updates focuses on modern pain management techniques. Traditional opioid-based treatments are being supplemented—or in some cases replaced—by emerging therapies like neurostimulation and ablation. These advancements provide safer, more effective pain relief and align with a broader movement toward non-pharmaceutical approaches.

Brett Seiling, a retired Air Force Colonel and competitor for Team U.S., competes in indoor rowing during the 2025 Invictus Games in Vancouver, Canada, Feb. 16, 2025. (Photo by Michel Sauret, U.S. Army Training and Doctrine Command)
Brett Seiling, a retired Air Force Colonel and competitor for Team U.S., competes in indoor rowing
during the 2025 Invictus Games in Vancouver, Canada, Feb. 16, 2025. (Photo by Michel Sauret, U.S.
Army Training and Doctrine Command)

Behavioral health is another major focus in the CPG. Research over the past five years has reinforced the connection between mental health and physical rehabilitation, underscoring the importance of addressing the emotional well-being of those with limb loss. 

“We’ve seen a surge of evidence supporting the integration of behavioral health into the rehabilitation process,” said Sparling. “Mental health and emotional recovery are just as important as physical healing.”

Additionally, the updated guidelines emphasize the role of peer support in recovery. While studies on peer visitor programs are still emerging, early research suggests that connecting service members with others who have undergone similar experiences can significantly improve outcomes. The CPG now includes recommendations that will drive further exploration in this area, helping refine best practices for peer support initiatives.

For USU, these guidelines represent more than just best practices—they are a mission-critical resource that reinforces the university’s leadership in military healthcare. 

“Providing world-class care to our wounded service members is mission-critical,” said Sparling. “These guidelines ensure that the MHS remains at the forefront of amputee rehabilitation, equipping our faculty and clinicians with the best tools to meet both current and future needs.”

The need for well-developed clinical practice guidelines has been reinforced by the lessons learned from military conflicts in Iraq and Afghanistan. Proactive preparation ensures that medical teams are equipped to respond effectively in times of crisis. 

Beyond shaping current care, the 2025 CPG also helps drive future research and innovation. By identifying gaps in evidence, the guidelines encourage further study in areas like rehabilitation dosing, pain management, and peer support programs. Sparling also serves as a principal investigator in the Center for Rehabilitation Sciences Research (CRSR), based in USU’s Department of PM&R. The mission of CRSR is to promote the advancement of rehabilitative care of injured service members with combat-related injuries, particularly those with limb loss, orthopedic trauma, and neurological complications. USU is committed to implementing these guidelines and ensuring that military healthcare professionals have the training, education, and resources needed to provide the best possible care.

At its core, this update is about improving lives and strengthening readiness. Through the combined efforts of USU, the DHA, and the VA, the 2025 CPG ensures that service members and veterans with limb loss receive the highest standard of care, helping them heal, regain function, and continue contributing to national defense.