Transcript EUMASS Burger.ppsx

Vocational
Considerations after
Amputations
Prof. Helena Burger, M.D., PhD
University Rehabilitation Institute, Ljubljana, Slovenia
University of Ljubljana, Faculty of Medicine
Disclosure
* Declare to have no conflicts of interests
Introduction
MARINČEK Č. The iron hand from
Slovenia. Prosthet Orthot Int 1992;16:
153-156.
Janez iz Kastva, 14th century
Introduction
Rehabilitation
Health condition
Body functions
and Structures
Activities
Environmental
Factors
Participation
Personal
Factors
Introduction
* Amputation impacts work economy,
particularly if it occurs in a younger
person in his or her productive years of
employment1
* Work-related amputations have
significant economic costs2
1 – Smith JJ et al. J Otrhopaed trauma 2005; 19: 249 – 53.
2 – McCall BP, Horwitz IB. Am J Indust Med 2006; 49: 1031 – 8.
Activity Limitations
Activity Limitations
Return to Work – LL
* 3.5 – 50.0% are unable to return to work
* ~ 15% retired because of amputation
* 55% stop working within the first 2 years
after amputation
* ~ 25% of employed – periods of
unemployment > 6 months
Burger H. In Krajbich JI et al. Atlas of Amputations and Limb
Deficiences AAOS 2016: 739 – 48.
Health Condition – LL
* Negative predictors of RtW:
Co-morbidities 1-3
Level of disability 4
Work related amputation aetiology 2
Co-morbid major injuries during event that
caused amputation 1
Problems with contra lateral limb 1
Phantom and residual limb pain 2
1 – Pezzin LE et al. Arch Phys Med Rehabil 2000; 81: 292 – 300.
2 – Schoppen T et al. Arch Phys Med Rehabil 2001; 82: 1425 – 31.
3 – Hebert JS, Ashworth NL.Disabil Rehabil 2006; 28: 613 – 8.
4 – Sheikh K. J Soc Occup Med 1985; 35: 114 – 7.
Body Functions – LL
* ↓ Muscle strength 1-3
* ↓ balance 1-3
* ↓ Range of motion –
ROM 1-3
* No studies whereas they
affect return to work
1 – van Velzen et al. Clin Rehabil 2006; 20: 999 – 1016.
2 – Matjačič Z et al. Prosthet Orthot Int 2003;27: 214 – 20.
3 – Raya MA et al. Prosthet orthot Int 2010; 34: 73 – 83.
Body Functions – LL
* ↓ Muscle strength
* ↓ balance
* ↓ ROM
Amputation – Body Structure
Body Structure – LL
* Up to 41 % - skin
problems 1, 2
* More problems:
Employed
Walking without
ambulatory aids 2
1 – Meulenbent HEJ et al. Disabil Rehabil 2006; 28: 603 – 8.
2 – Dudek NL et al. Arch Phys Med Rehabil 2005;86: 659–63.
Activities – LL
* Walking distance –
clinically relevant
influence 1
* Positive predictors 2 :
Better physical
functioning 3 months after
amputation
Lower disability level
1 – Schopen T et al. Arch Phys Med Rehabil 2001; 82: 1425 – 31.
2 – MacKenzie EJ et al. J Trauma 2006; 61: 688 – 94.
Environmental Factors – LL
* Prosthesis 1 :
 frequency of stumbles, falls
Good mobility
Allows activities that require
divided attention
* For some work specific
adaptations 2
1 – Dasgupta AK et al. Occup Med (Lond) 1997; 47: 228 - 36.
2 – Grossman A et al. Aviat Space Environ Med 2005; 76: 403 – 5.
Environmental Factors – LL
* Problems with the prosthesis are
among the major reasons for reduced
productivity 1
1 – Fisher K et al. Int J Rehabil Res 2003; 26: 51 – 6.
Environmental Factors – LL
Environmental Factors – LL
* Type of work:
4 – 60% change to a different job1, 2
Most move 1 – 3 grades below their
preamputation classification 3
The demand of the job decreased from
12.1 to 8.3 (scale 0 – 16) 4
1 – Kegel B et al. Arch Phys Med Rehabil 1978; 59: 101 – 120.
2 – Purry NA et al. Injury 1989; 20: 32 – 6.
3 – Whyte AS et al. Disabil Rehabil 2002; 24. 462 – 70.
4 – Pezzin LE et al. Arch Phys Med Rehabil 2000; 81: 292 – 300.
Environmental Factors – LL
* 28 – 43% require
job adaptations 1, 2
* Almost 1/3 partially
dependent on
colleagues 3
1 – van dr Sluis CK et al. Prosthet Orthot Int 2009; 33: 41 – 51.
2 – Schoppen T et al. Arch Phys Med Rehabil 2001; 82: 239 – 45.
3 – Fisher K et al. Int J Rehabil Res 2003; 26: 51 – 6.
Environmental Factors – LL
* Fewer possibilities for
promotion 1
* Lower salary 2
57%
dissatisfied 3
1 – Schoppen T et al. Arch Phys Med Rehabil 2001; 82: 239 – 45.
2 – Livingstone DH et al. J trauma 1994; 37: 494 – 99.
3 – Nissen SJ et al. Arch Phys Med Rehabil 1992; 73: 548 – 51.
Environmental Factors – LL
* Support:
Colleagues, supervisors
Vocational rehab
* Transportation services
* Legal and social security services –
disability benefits
* Health services, systems and policies
Burger H. In Krajbich JI et al. Atlas of Amputations and Limb
Deficiences AAOS 2016: 739 – 48.
Personal Factors – LL
* Sex – inconsistent findings
* Age – younger age – positive
predictor
* Education – higher
education – positive predictor
Burger H. In Krajbich JI et al. Atlas of Amputations and Limb
Deficiences AAOS 2016: 739 – 48.
Health Condition – UL
* Negative predictors of RtW:
Depression 1
Phantom and residual limb pain 2 - 4
Secondary impairments 5
1 – Reed D. Orthop Nurs 2004; 23: 397 – 402.
2 – Whyte AS, Carroll LJ. Disabil Rehabil 2002; 24: 462 – 70.
3 – Millstein S et al. Prosthet orthot Int 1985; 9: 69 – 78.
4 – Yang CH et al. Ann Rehabil Med 2011; 35: 907 – 21.
5 – Østlie K et al. Arch Phys Med Rehabil 2011; 92: 1967 – 73.
Body Functions – UL
* No studies
Amputation – Body Structure
Body Structure – UL
* Cause of amputation :
Work related injuries –
very few return 1
Longer time to return 2
1 – Livingstone DH et al. J Trauma 1994; 37:
495 – 9.
2 – Sagiv P et al. Plast Reconstr Surg
2002;110: 497 – 503.
Activities – UL
Environmental Factors – UL
* Prosthesis 1-4 :
Work with or without:
• Type of work – unskilled without 2
• Type of prosthesis
16% - prosthesis main factor
preventing RtW5
1 – Jones LE et al. Disabil Rehabil 1995; 17: 437 - 42.
2 – Stürup J et al. Prosthet Orthot Int 1988; 12: 50 – 2.
3 – Pylatiuk C et al. Prosthet Orthot Int 2007; 31: 362 – 70.
4 – Østlie k et al. Disabil rehabil Assist tecnol 2012; 7: 479 – 93.
5 – Jang CH et al. Ann Rehabil Med 2011; 35: 907 – 21.
Environmental Factors – UL
* 35% used body-powered prosthesis1
* 271 – 80%2 myoelectric one
1 – Silcox DH et al. J Bone Joint Surg Am 1993; 75: 1781 – 9.
2 – Pylatiuk C et al. Prosthet Orthot Int 2007; 31: 362 – 70.
Environmental Factors – UL
Environmental Factors – UL
* Type of work:
20 – 100% change to a different job13
From unskilled manual work to
clerical1, 2, 4
1 – Jones LE et al. Disabil Rehabil 1995; 17: 437 – 42.
2 – Fernández A et al. Prosthet Orthot Int 2000; 24: 143 – 7.
3 – Jang CH et al. Ann Rehabil Med 2011; 35: 907 – 21.
4 – Davidson J. J Hand Ther 2002; 15: 62 – 70.
Environmental Factors – LL
* 28 – 43% require job adaptations1-3:
 Task
 Level of amputation
 Type of prosthesis
1 – van dr Sluis CK et al. Prosthet Orthot Int 2009; 33: 41 – 51.
2 – Schoppen T et al. Arch Phys Med Rehabil 2001; 82: 239 – 45.
3 – Girdhar A et al. J Occup Rehabil 2001; 11: 99 – 118.
Environmental Factors – UL
* Barriers perceived by >50%1:
Laws
Regulations
Entitlements
1 – Gallagher P et al. Prosthet Orthot Int 2011; 35: 278 – 84.
Environmental Factors
Health
Labour
Environmental Factors – UL
Medical
rehabilitation
Psychosocial
rehabilitation
Patient
Comprehensive
Rehabilitation
Vocational
rehabilitation
Personal Factors – UL
* Sex – inconsistent findings
* Age – younger than 50
* Education – no influence on RtW
Burger H. In Krajbich JI et al. Atlas of Amputations and Limb
Deficiences AAOS 2016: 739 – 48.
Conclusion
* Start as soon as
possible
* Comprehensive
rehabilitation
* Laws and regulations
14th Congress of the
European Forum for Research in Rehabilitation
(EFRR)
Wednesday 24th - Saturday 27th May 2017
Glasgow Caledonian University, Glasgow
Thank
you very
much for
your
attention!
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