Return to Work Following Major Limb Loss
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.
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