Return to Work Following Major Limb Loss

Part of the Handbooks in Health, Work, and Disability book series (SHHDW, volume 1)

Abstract

Amputation results in a permanent change in body structure, which may or may not be partially compensated with prosthetic rehabilitation. The goal after amputation is to reduce activity limitations and increase participation, including return to work as an integral component. Following amputation there are significant challenges in return to work and return to same occupation.

In lower limb amputation, the more proximal the loss, the greater the mobility restriction. However, success in return to work is strongly affected by age and pre-amputation function. In general, two-thirds of people return to work after lower limb amputation, after about 1 year, to less physically demanding occupations. The level of amputation does not affect return to work, but if a person is successfully fit with a prosthesis, this has a positive impact on return to work. Younger age and greater level of education also positively affect return-to-work outcome, as does support from the employer. The prolonged length of time commonly reported to return to work should have important implications on policy development. The suggestion that there is better job reintegration and satisfaction in the workplace with change in job also suggests an important role for vocational retraining and vocational rehabilitation in the first year after amputation, to facilitate replacement in the work force.

For upper limb amputation, there are surprisingly similar types of barriers to return to work regardless of level of amputation (from partial hand to shoulder-level amputation), although the type of employment is the major consideration in success of return to work. There may be more psychological adjustment issues for upper limb amputation due to the visibility of the loss, which can affect reintegration to the workplace.

References

  1. Alvaro, R. (2004). Psychological factors in work-related amputation: Considerations for rehabilitation counselors. The Journal of Rehabilitation, 70(4), 6–15.Google Scholar
  2. Atesalp, A. S., Erler, K., Gur, E., Koseglu, E., Kirdemir, V., & Demiralp, B. (1999). Bilateral lower limb amputations as a result of landmine injuries. Prosthetics and Orthotics International, 23(1), 50–54.PubMedGoogle Scholar
  3. Bondurant, F. J., Cotler, H. B., Buckle, R., Miller-Crotchett, P., & Browner, B. D. (1988). The medical and economic impact of severely injured lower extremities. The Journal of Trauma, 28(8), 1270–1273.CrossRefPubMedGoogle Scholar
  4. Boynton, B. L. (1955). The rehabilitation and the re-employment potential of the amputee. American Journal of Surgery, 89(4), 924–931.CrossRefPubMedGoogle Scholar
  5. Bruins, M., Geertzen, J. H., Groothoff, J. W., & Schoppen, T. (2003). Vocational reintegration after a lower limb amputation: A qualitative study. Prosthetics and Orthotics International, 27(1), 4–10.PubMedGoogle Scholar
  6. Burger, H. (2010). Return to work after amputation. In C. Murray (Ed.), Amputation, prosthesis use, and phantom limb pain: An interdisciplinary perspective (pp. 101–114). New York, NY: Springer.Google Scholar
  7. Burger, H., Kuzelicki, J., & Marinček, Č. (2005). Transition from sitting to standing after trans-femoral amputation. Prosthetics and Orthotics International, 29(2), 139–151.CrossRefPubMedGoogle Scholar
  8. Burger, H., & Marinček, Č. (2007). Return to work after lower limb amputation. Disability and Rehabilitation, 29(17), 1323–1329.CrossRefPubMedGoogle Scholar
  9. Burger, H., Maver, T., & Marincek, C. (2007). Partial hand amputation and work. Disability and Rehabilitation, 29(17), 1317–1321.CrossRefPubMedGoogle Scholar
  10. Cavanagh, S. R., Shin, L. M., Karamouz, N., & Rauch, S. L. (2006). Psychiatric and emotional sequelae of surgical amputation. Psychosomatics, 47(6), 459–464.CrossRefPubMedGoogle Scholar
  11. Cheung, E., Alvaro, R., & Colotla, V. A. (2003). Psychological distress in workers with traumatic upper- or lower-limb amputations following industrial injuries. Rehabilitation Psychology, 48(2), 109–112.CrossRefGoogle Scholar
  12. Chow, S. P., & Ng, C. (1993). Hand function after digital amputation. Journal of Hand Surgery (Edinburgh, Scotland), 18(1), 125–128.CrossRefGoogle Scholar
  13. Copuroglu, D., Ozcan, M., Yilmaz, B., Gorgulu, Y., Abay, E., & Yalniz, E. (2010). Acute stress disorder and posttraumatic stress disorder following traumatic amputation. Acta Orthopaedica Belgica, 76(1), 90–93.PubMedGoogle Scholar
  14. Curley, M. D., Walsh, J. M., & Triplett, R. G. (1982). Some adjustment indices of oral-maxillofacial war casualties, limb amputees, and noninjured veterans. Military Medicine, 147(7), 572–574.PubMedGoogle Scholar
  15. Dasgupta, A. K., McCluskie, P. J., Patel, V. S., & Robins, L. (1997). The performance of the ICEROSS prostheses amongst transtibial amputees with a special reference to the workplace—A preliminary study. Icelandic roll on silicone socket. Occupational Medicine (Oxford, England), 47(4), 228–236.CrossRefGoogle Scholar
  16. Datta, D., Selvarajah, K., & Davey, N. (2004). Functional outcome of patients with proximal upper limb deficiency-acquired and congenital. Clinical Rehabilitation, 18(2), 172–177.CrossRefPubMedGoogle Scholar
  17. Davidson, J. (2002). A survey of the satisfaction of upper limb amputees with their prostheses, their lifestyles, and their abilities. Journal of Hand Therapy, 15(1), 62–70.CrossRefPubMedGoogle Scholar
  18. Dillingham, T. R., Pezzin, L. E., & MacKenzie, E. J. (2002). Limb amputation and limb deficiency: Epidemiology and recent trends in the United States. Southern Medical Journal, 95(8), 875–883.PubMedGoogle Scholar
  19. Dougherty, P. J. (1999). Long-term follow-up study of bilateral above-the-knee amputees from the Vietnam war. The Journal of Bone and Joint Surgery, 81(10), 1384–1390. American Volume.PubMedGoogle Scholar
  20. Dudek, N. L., Marks, M. B., Marshall, S. C., & Chardon, J. P. (2005). Dermatologic conditions associated with use of a lower-extremity prosthesis. Archives of Physical Medicine and Rehabilitation, 86(4), 659–663.CrossRefPubMedGoogle Scholar
  21. Dumontier, C. (2003). Distal replantation, nail bed, and nail problems in musicians. Hand Clinics, 19(2), 259–272.CrossRefPubMedGoogle Scholar
  22. Ebrahimzadeh, M. H., & Rajabi, M. T. (2007). Long-term outcomes of patients undergoing war-related amputations of the foot and ankle. The Journal of Foot and Ankle Surgery, 46(6), 429–433.CrossRefPubMedGoogle Scholar
  23. Ephraim, P. L., Dillingham, T. R., Sector, M., Pezzin, L. E., & Mackenzie, E. J. (2003). Epidemiology of limb loss and congenital limb deficiency: A review of the literature. Archives of Physical Medicine and Rehabilitation, 84(5), 747–761.CrossRefPubMedGoogle Scholar
  24. Fernandez, A., Isusi, I., & Gomez, M. (2000). Factors conditioning the return to work of upper limb amputees in Asturias, Spain. Prosthetics and Orthotics International, 24(2), 143–147.CrossRefPubMedGoogle Scholar
  25. Ferrapie, A. L., Brunel, P., Besse, W., Altermatt, E., Bontoux, L., & Richard, I. (2003). Lower limb proximal amputation for a tumour: A retrospective study of 12 patients. Prosthetics and Orthotics International, 27(3), 179–185.CrossRefPubMedGoogle Scholar
  26. Fisher, K., Hanspal, R. S., & Marks, L. (2003). Return to work after lower limb amputation. International Journal of Rehabilitation Research, 26(1), 51–56.CrossRefPubMedGoogle Scholar
  27. Gaine, W. J., Smart, C., & Bransby-Zachary, M. (1997). Upper limb traumatic amputees. Review of prosthetic use. Journal of Hand Surgery (Edinburgh, Scotland), 22(1), 73–76.CrossRefGoogle Scholar
  28. Gallagher, P., & Maclachlan, M. (2001). Adjustment to an artificial limb: A qualitative perspective. Journal of Health Psychology, 6(1), 85–100.CrossRefPubMedGoogle Scholar
  29. Gallagher, P., O'Donovan, M. A., Doyle, A., & Desmond, D. (2011). Environmental barriers, activity limitations and participation restrictions experienced by people with major limb amputation. Prosthetics and Orthotics International, 35(3), 278–284.CrossRefPubMedGoogle Scholar
  30. Girdhar, A., Mital, A., Kephart, A., & Young, A. (2001). Design guidelines for accommodating amputees in the workplace. Journal of Occupational Rehabilitation, 11(2), 99–118.CrossRefPubMedGoogle Scholar
  31. Gonzales, E. G., & Corcoran, P. J. (1994). Energy expenditure during ambulation. In J. A. Downey, S. J. Myers, E. G. Gonzales, & J. S. Lieberman (Eds.), The physiological basis of rehabilitation medicine (2nd ed., p. 431). Newton, MA: Butterworth-Heineman.Google Scholar
  32. Grossman, A., Goldstein, L., Heim, M., Barenboim, E., & Dudkiewicz, I. (2005). Trans-femoral amputee pilots: Criteria for return to the fighter cockpit. Aviation, Space and Environmental Medicine, 76(4), 403–405.Google Scholar
  33. Hacking, H. G. A., van der Berg, J. P., Dahmen, K. T., & Post, M. W. M. (1997). Long-term outcomes of upper limb prosthetic use in the Netherlands. European Journal of Physical Medicine and Rehabilitation, 7(6), 179–181.Google Scholar
  34. Hattori, Y., Doi, K., Ikeda, K., & Estrella, E. P. (2006). A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations. The Journal of Hand Surgery, 31(5), 811–818.CrossRefPubMedGoogle Scholar
  35. Hebert, J. S., & Ashworth, N. L. (2006). Predictors of return to work following traumatic work-related lower extremity amputation. Disability and Rehabilitation, 28(10), 613–618.CrossRefPubMedGoogle Scholar
  36. Hopper, R. A., Griffiths, S., Murray, J., & Manktelow, R. T. (2000). Factors influencing use of digital prostheses in workers’ compensation recipients. The Journal of Hand Surgery, 25(1), 80–85.CrossRefPubMedGoogle Scholar
  37. Horgan, O., & MacLachlan, M. (2004). Psychosocial adjustment to lower-limb amputation: A review. Disability and Rehabilitation, 26(14-15), 837–850.CrossRefPubMedGoogle Scholar
  38. Hung, L. K., Ho, K. K., & Leung, P. C. (1999). Impairment of hand function and loss of earning capacity after occupational hand injury: Prospective cohort study. Hong Kong Medical Journal, 5(3), 245–250.PubMedGoogle Scholar
  39. Ide, M., Obayashi, T., & Toyonaga, T. (2002). Association of pain with employment status and satisfaction among amputees in Japan. Archives of Physical Medicine and Rehabilitation, 83(10), 1394–1398.CrossRefPubMedGoogle Scholar
  40. Jones, L. E., & Davidson, J. H. (1995). The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia. Disability and Rehabilitation, 17(8), 437–442.CrossRefPubMedGoogle Scholar
  41. Jones, L., Hall, M., & Schuld, W. (1993). Ability or disability? A study of the functional outcome of 65 consecutive lower limb amputees treated at the Royal South Sydney hospital in 1988–1989. Disability and Rehabilitation, 15(4), 184–188.CrossRefPubMedGoogle Scholar
  42. Kegel, B., Carpenter, M. L., & Burgess, E. M. (1978). Functional capabilities of lower extremity amputees. Archives of Physical Medicine and Rehabilitation, 59(3), 109–120.PubMedGoogle Scholar
  43. Kejlaa, G. H. (1992). The social and economic outcome after upper limb amputation. Prosthetics and Orthotics International, 16(1), 25–31.PubMedGoogle Scholar
  44. Kishbaugh, D., Dillingham, T. R., Howard, R. S., Sinnott, M. W., & Belandres, P. V. (1995). Amputee soldiers and their return to active duty. Military Medicine, 160(2), 82–84.PubMedGoogle Scholar
  45. Kratz, A. L., Williams, R. M., Turner, A. P., Raichle, K. A., Smith, D. G., & Ehde, D. (2010). To lump or to split? Comparing individuals with traumatic and nontraumatic limb loss in the first year after amputation. Rehabilitation Psychology, 55(2), 126–138.CrossRefPubMedGoogle Scholar
  46. Kuzelicki, J., Zefran, M., Burger, H., & Bajd, T. (2005). Synthesis of standing-up trajectories using dynamic optimization. Gait & Posture, 21(1), 1–11.CrossRefGoogle Scholar
  47. Lifchez, S. D., Marchant-Hanson, J., Matloub, H. S., Sanger, J. R., Dzwierzynski, W. W., & Nguyen, H. H. (2005). Functional improvement with digital prosthesis use after multiple digit amputations. The Journal of Hand Surgery, 30(4), 790–794.CrossRefPubMedGoogle Scholar
  48. Livingston, D. H., Keenan, D., Kim, D., Elcavage, J., & Malangoni, M. A. (1994). Extent of disability following traumatic extremity amputation. The Journal of Trauma, 37(3), 495–499.CrossRefPubMedGoogle Scholar
  49. MacKenzie, E. J., Bosse, M. J., Kellam, J. F., Pollak, A. N., Webb, L. X., Swiontkowski, M. F., et al. (2006). Early predictors of long-term work disability after major limb trauma. The Journal of Trauma, 61(3), 688–694.CrossRefPubMedGoogle Scholar
  50. Matthews, L. R. (2005). Work potential in adult survivors of road accidents with and without posttraumatic stress disorder. Behaviour Research and Therapy, 43(4), 475–483.CrossRefPubMedGoogle Scholar
  51. McCall, B. P., & Horwitz, I. B. (2006). An assessment and quantification of the rates, costs, and risk factors of occupational amputations: Analysis of Kentucky workers’ compensation claims, 1994–2003. American Journal of Industrial Medicine, 49(12), 1031–1038.CrossRefPubMedGoogle Scholar
  52. Michael, J. W. (1992). Prosthetic and orthotic management. In H. Bowker & J. W. Michael (Eds.), Atlas of limb prosthetics: Surgical, prosthetic, and rehabilitation principles (pp. 217–226). St. Louis, MO: Mosby.Google Scholar
  53. Miguelez, J., Conyers, D., Lang, M., & Gulick, K. (2009). Upper extremity prosthetics. In P. F. Pasquina & R. A. Cooper (Eds.), Care of the combat amputee (pp. 607–640). Falls Church, VA: Office of the Surgeon General at TMM Publications.Google Scholar
  54. Millstein, S., Bain, D., & Hunter, G. A. (1985). A review of employment patterns of industrial amputees: Factors influencing rehabilitation. Prosthetics and Orthotics International, 9(2), 69–78.PubMedGoogle Scholar
  55. Millstein, S. G., Heger, H., & Hunter, G. A. (1986). Prosthetic use in adult upper limb amputees: A comparison of the body powered and electrically powered prostheses. Prosthetics and Orthotics International, 10(1), 27–34.PubMedGoogle Scholar
  56. Nagarajan, R., Neglia, J. P., Clohisy, D. R., Yasui, Y., Greenberg, M., Hudson, M., et al. (2003). Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: A report from the childhood cancer survivor study. Cancer, 97(10), 2554–2564.CrossRefPubMedGoogle Scholar
  57. Narang, I. C., Mathur, B. P., Singh, P., & Jape, V. S. (1984). Functional capabilities of lower limb amputees. Prosthetics and Orthotics International, 8(1), 43–51.PubMedGoogle Scholar
  58. Nissen, S. J., & Newman, W. P. (1992). Factors influencing reintegration to normal living after amputation. Archives of Physical Medicine and Rehabilitation, 73(6), 548–551.PubMedGoogle Scholar
  59. Nowroozi, F., Salvanelli, M. L., & Gerber, L. H. (1983). Energy expenditure in hip disarticulation and hemipelvectomy amputees. Archives of Physical Medicine and Rehabilitation, 64(7), 300–303.PubMedGoogle Scholar
  60. Opsteegh, L., Reinders-Messelink, H. A., Schollier, D., Groothoff, J. W., Postema, K., Dijkstra, P. U., et al. (2009). Determinants of return to work in patients with hand disorders and hand injuries. Journal of Occupational Rehabilitation, 19, 245–255.PubMedCentralCrossRefPubMedGoogle Scholar
  61. Peacock, J. M., Keo, H. H., Duval, S., Baumgartner, I., Oldenburg, N. C., Jaff, M. R., et al. (2011). The incidence and health economic burden of ischemic amputation in Minnesota, 2005–2008. Preventing Chronic Disease, 8(6), A141.PubMedCentralPubMedGoogle Scholar
  62. Pedersen, P., & Damholt, V. (1994). Rehabilitation after amputation following lower limb fracture. The Journal of Trauma, 36(2), 195–197.CrossRefPubMedGoogle Scholar
  63. Pernot, H. F., de Witte, L. P., Lindeman, E., & Cluitmans, J. (1997). Daily functioning of the lower extremity amputee: An overview of the literature. Clinical Rehabilitation, 11(2), 93–106.CrossRefPubMedGoogle Scholar
  64. Pernot, H. F., Winnubst, G. M., Cluitmans, J. J., & de Witte, L. P. (2000). Amputees in Limburg: Incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year. Prosthetics and Orthotics International, 24(2), 90–96.CrossRefPubMedGoogle Scholar
  65. Pezzin, L. E., Dillingham, T. R., Mackenzie, E. J., Ephraim, P., & Rossbach, P. (2004). Use and satisfaction with prosthetic limb devices and related services. Archives of Physical Medicine and Rehabilitation, 85(5), 723–729.CrossRefPubMedGoogle Scholar
  66. Pezzin, L. E., Dillingham, T. R., & MacKenzie, E. J. (2000). Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Archives of Physical Medicine and Rehabilitation, 81(3), 292–300.CrossRefPubMedGoogle Scholar
  67. Pinzur, M. S., Angelats, J., Light, T. R., Izuierdo, R., & Pluth, T. (1994). Functional outcome following traumatic upper limb amputation and prosthetic limb fitting. The Journal of Hand Surgery, 19(5), 836–839.CrossRefPubMedGoogle Scholar
  68. Pohjolainen, T., Alaranta, H., & Karkkainen, M. (1990). Prosthetic use and functional and social outcome following major lower limb amputation. Prosthetics and Orthotics International, 14(2), 75–79.PubMedGoogle Scholar
  69. Pylatiuk, C., Schulz, S., & Doderlein, L. (2007). Results of an internet survey of myoelectric prosthetic hand users. Prosthetics and Orthotics International, 31(4), 362–370.CrossRefPubMedGoogle Scholar
  70. Rack, A., & Hofmann, G. O. (2003). Psychological and social impact of lower limb amputation following trauma – A retrospective evaluation of the amputation moment. Aktuelle Traumatologie, 33(5), 228–235.CrossRefGoogle Scholar
  71. Reed, D. (2004). Understanding and meeting the needs of farmers with amputations. Orthopaedic Nursing/National Association of Orthopaedic Nurses, 23(6), 397–402. 404–405.Google Scholar
  72. Ross, C., & Mirowsky, J. (1995). Does employment affect health? Journal of Health and Social Behavior, 36(3), 230–243.CrossRefPubMedGoogle Scholar
  73. Rotter, K., Sanhueza, R., Robles, K., & Godoy, M. (2006). A descriptive study of traumatic lower limb amputees from the hospital del Trabajador: Clinical evolution from the accident until rehabilitation discharge. Prosthetics and Orthotics International, 30(1), 81–86.CrossRefPubMedGoogle Scholar
  74. Rybarczyk, B., Nyenhuis, D. L., Nicholas, J. J., Dash, S. M., & Kaiser, J. (1995). Body image, perceived social stigma, and the prediction of psychosocial adjustment to leg amputation. Rehabilitation Psychology, 40(2), 95–110.CrossRefGoogle Scholar
  75. Saddawi-Konefka, D., Kim, H. M., & Chung, K. C. (2008). A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plastic and Reconstructive Surgery, 122(6), 1796–1805.PubMedCentralCrossRefPubMedGoogle Scholar
  76. Sagiv, P., Shabat, S., Mann, M., Ashur, H., & Nyska, M. (2002). Rehabilitation process and functional results of patients with amputated fingers. Plastic and Reconstructive Surgery, 110(2), 497–503.CrossRefPubMedGoogle Scholar
  77. Schoppen, T., Boonstra, A., Groothoff, J. W., de Vries, J., Göeken, L. N. H., & Eisma, W. H. (2001a). Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in the Netherlands. Archives of Physical Medicine and Rehabilitation, 82(2), 239–245.CrossRefPubMedGoogle Scholar
  78. Schoppen, T., Boonstra, A., Groothoff, J. W., de Vries, J., Goeken, L. N., & Eisma, W. H. (2002). Job satisfaction and health experience of people with a lower-limb amputation in comparison with healthy colleagues. Archives of Physical Medicine and Rehabilitation, 83(5), 628–634.CrossRefPubMedGoogle Scholar
  79. Schoppen, T., Boonstra, A., Groothoff, J. W., Sonderen, E. V., Goumleken, L. N., & Eisma, W. H. (2001b). Factors related to successful job reintegration of people with a lower limb amputation. Archives of Physical Medicine and Rehabilitation, 82(10), 1425–1431.CrossRefPubMedGoogle Scholar
  80. Silcox, D. H., 3rd, Rooks, M. D., Vogel, R. R., & Fleming, L. L. (1993). Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses. The Journal of Bone and Joint Surgery, 75(12), 1781–1789. American Volume.PubMedGoogle Scholar
  81. Smith, J. J., Agel, J., Swiontkowski, M. F., Castillo, R., Mackenzie, E., Kellam, J. F., et al. (2005). Functional outcome of bilateral limb threatening: Lower extremity injuries at two years post injury. Journal of Orthopaedic Trauma, 19(4), 249–253.CrossRefPubMedGoogle Scholar
  82. Sturup, J., Thyregod, H. C., Jensen, J. S., Retpen, J. B., Boberg, G., Rasmussen, E., et al. (1988). Traumatic amputation of the upper limb: The use of body-powered prostheses and employment consequences. Prosthetics and Orthotics International, 12(1), 50–52.PubMedGoogle Scholar
  83. Uiterwijk, A. E., Remerie, S. C., Rol, M., Sier, J. C., Stam, H. J., & Terburg, M. (1997). Routing through the health care system and level of functioning of lower limb amputees. Clinical Rehabilitation, 11(3), 253–262.CrossRefPubMedGoogle Scholar
  84. Weed, R. O., Kirkscey, M., Taylor, C. M., & Mullins, G. (1997). Return to work rates in cases of amputation. Journal of Rehabilitation Outcomes Measurement, 1(4), 35–39.Google Scholar
  85. Whyte, A. S., & Carroll, L. J. (2002). A preliminary examination of the relationship between employment, pain and disability in an amputee population. Disability and Rehabilitation, 24(9), 462–470.CrossRefPubMedGoogle Scholar
  86. Williams, R. M., Ehde, D. M., Smith, D. G., Czerniecki, J. M., Hoffman, A. J., & Robinson, L. R. (2004). A two-year longitudinal study of social support following amputation. Disability and Rehabilitation, 26(14-15), 862–874.CrossRefPubMedGoogle Scholar
  87. World Health Organization (WHO). (2001). The international classification of functioning, disability and health (ICF). Geneva: Author.Google Scholar
  88. Wright, T. W., Hagen, A. D., & Wood, M. B. (1995). Prosthetic usage in major upper extremity amputations. The Journal of Hand Surgery, 20(4), 619–622.CrossRefPubMedGoogle Scholar
  89. Xu, J., Kohler, F., & Dickson, H. (2011). Systematic review of concepts measured in individuals with lower limb amputation using the international classification of functioning, disability and health as a reference. Prosthetics and Orthotics International, 35(3), 262–268.CrossRefPubMedGoogle Scholar
  90. Yonemoto, T., Ishii, T., Takeuchi, Y., Kimura, K., Hagiwara, Y., & Tatezaki, S. (2007). Education and employment in long-term survivors of high-grade osteosarcoma: A Japanese single-center experience. Oncology, 72(5-6), 274–278.CrossRefPubMedGoogle Scholar
  91. Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89(3), 422–429.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Physical Medicine & RehabilitationUniversity of AlbertaEdmontonCanada
  2. 2.Medical DepartmentsUniversity Rehabilitation InstituteLjubljanaSlovenia

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