Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A Review of the Literature

Abstract

Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature exploring the impact of amputation upon a person's functioning and inclusion in the workplace. Methods Medline, CINAHL, and PsycINFO were searched using keywords related to amputation, employment and community reintegration. Eligible studies were published since 2000 and one of the following study designs: randomized controlled trial, non-randomized controlled trial, retrospective study, prospective study, concurrent cohort study, or cross sectional study. Studies for civilians with amputation as well as service members and Veterans with amputation were considered for inclusion. Results The search identified 995 articles, 25 of which met inclusion/exclusion criteria and were included in the review. While strong evidence for correlations and predictors of outcomes after amputation were limited, multiple factors were identified as contributing to physical functioning and employment after amputation. Conclusions Outcomes after amputation can vary widely with many potentially inter-related factors contributing. The factors identified may also serve to inform the development of interventions aiming to improve functional performance and reintegration after amputation. Furthermore, the review highlights the need for more high quality prospective studies.

Balance-confidence is associated with community participation, perceived physical mobility, and performance-based function among individuals with a unilateral amputation

“…age, mental status, amputation level) that have been previously related to post-amputation participation, balance-confidence may be a modifiable factor that if addressed, may improve functional mobility and community reintegration. Younger adults who experience an amputation are more likely to return to work post-amputation (Darter et al, 2018). At 1 year post-amputation, better baseline mental status and premorbid mobility, as well as lower levels of amputation, have been associated with higher levels of societal participation (Roepke et al, 2017).…”

Education Level Among Patients with Major Limb Amputation

“…Each year, an estimated 185,000 people undergo amputation in the United States, with the overall number of amputations being performed increasing [3,4]. Furthermore, nearly two million individuals have some level of limb amputation, with most amputations affecting the lower limb [3,5]. In addition, the state of South Carolina has one of the highest rates of major limb amputation in the country, with Florence and neighboring counties particularly affected [6,7].…”

“…Furthermore, maintaining mobility, functional level, and preventing complications from prosthetic use is a critical part of the long-term management of patients with major limb amputation. Variables such as age, etiology of amputation, level of amputation, bilateral amputation, body mass index, phantom and residual limb pain, co-morbidities, marital status, psychosocial support, and access to medical care and rehabilitation services can affect adjustment to amputation, post-amputation and prosthetic rehabilitation, and long-term prosthetic use [4,5,[13][14][15]. Education level has also been previously cited to affect different outcome measures and mortality after amputation.…”

“…Nunes et al found that patients with low education level showed lower rates of adaptation to prosthesis [14]. In a review of the literature, Darter et al found that education level was associated with return to work rates [5]. Amputees with higher education level had more job opportunities and more flexibility in their work schedules [5].…”

“…In a review of the literature, Darter et al found that education level was associated with return to work rates [5]. Amputees with higher education level had more job opportunities and more flexibility in their work schedules [5]. Corey et al showed increased five-year mortality for patients who did not complete high school education compared to those who completed high school education [16].…”