Introduction: After upper-limb amputation, employment opportunities may be limited. Given the dramatic shift in the job market in the United States in the recent years, there is a need to examine the updated employment rates and the types of occupations to which individuals with amputation can return to. In this study, we assessed current employment status for people with upper-limb loss and determined whether these individuals needed to change jobs as a result of limb loss. Second, we examined whether demographic or impairment-specific factors were correlated with employment status or the need to switch jobs.
Materials and methods: Individuals with upper-limb amputation provided personal and employment information in an online survey. We explored the bivariate relationships between employment status and 11 personal factors (e.g., age at amputation, highest education level). Using the significant factors from this analysis, we built a logistic regression model for postamputation employment status. We also explored the relationship between these same 11 factors and the individuals' need to switch jobs after limb loss.
Results: A total of 199 and 160 respondents were deemed eligible for the employment status and job switch analyses, respectively. Of the working-aged respondents, 60.8% (121/199) were employed at the time of survey. Twenty-nine percent (47/160) reported needing to change jobs because of their amputation. Factors negatively associated with employment included having a bilateral amputation, lower education level, older age at amputation, higher pain frequency, and wearing a prosthesis less frequently. Higher education level was the only significant predictor of successful employment in the logistic regression model. There were no significant relationships between any factor and the need to change jobs after amputation.
Conclusions: The results suggest that individuals with upper-limb amputation have a lower employment rate than the national average. Future work should focus on understanding the reasons behind employment challenges in this population. (J Prosthet Orthot. 2022;34:79–88)
The loss of an upper limb dramatically affects an individual's daily life, resulting in major deficiencies in bimanual motor function and sensation. These deficits are only partially restored by currently available prosthetic technology. Therefore, individuals with upper-limb amputation must make major adjustments to their lifestyles, potentially including finding a new occupation. Although reintegration into the workforce is a primary goal of therapy after amputation, reentering the job market may still present a significant challenge. In fact, one study found that 91.7% (n = 12) of individuals reported difficulty in finding employment after upper-limb amputation.
It is difficult to determine the influence of upper-limb amputation on current employment trends as most previous studies occurred more than 15 years ago. According to the Organization for Economic Cooperation and Development (OECD), there has been a dramatic shift in the US job structure over the past few decades toward positions, with a “greater dependence on knowledge, information, and high skill levels.” There are multiple theories that explain this shift in employment trends, including the effects of computerization and increased use of technology. For instance, jobs that require a higher level of education and rely on cognitive skills may benefit from computer technology, whereas some jobs that are more routine and manual may be replaced by automation. A study in 2017 focused on amputation due to upper-limb occupational injuries and was unable to capture this shift in the job structure because most participants had jobs involving manual work. Another survey in 2016 found that most individuals with acquired upper-limb amputation (66.7%, n = 110) were employed in mentally demanding jobs, rather than physically demanding jobs. Given the recent shift in the required job skill set, there is a need to investigate current occupational trends in individuals with upper-limb amputation.
Successful reemployment after upper-limb amputation is likely related to a variety of personal, impairment-specific, and environmental factors. Several studies have tried to determine these factors, often with conflicting results. One study found that individuals who do not use a prosthesis were more likely to return to work, whereas others found that greater prosthesis use was associated with higher reemployment rates. Similarly, residual limb pain was negatively associated with employment after amputation in some studies, but not in others. In contrast, studies generally agreed that amputation at a younger age is positively associated with employment rates after amputation. Although most of these previous studies focused on identifying impairment-specific factors such as amputation characteristics, other studies have investigated the effect of more personal and environmental factors on postamputation employment. These studies have shown that the level of motivation to return to work, or work self-efficacy, is an important factor influencing return-to-work status in individuals with lower-limb amputation and that the ability to modify jobs plays an important role in whether individuals stay in the workforce after amputation.
The goal of this work was to provide updated information on current employment rates for people with upper-limb loss and to better understand the types of jobs to which they are able to return to. In addition, we investigated the relationship between a range of general and impairment-specific factors and employment status, as well as the need to switch jobs after limb loss. We used significant factors from this analysis to build an exploratory logistic regression model to identify predictors of employment status and the need to switch jobs after amputation.
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