Which way to work? Factors influencing participation in the workforce: perspectives of people with upper limb amputations and limb deficiencies

Submission note: A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Science (Occupational Therapy) to the Department of Occupational Therapy, School of Allied Health, Faculty of Science, Health & Engineering, La Trobe University, Victoria.

Participation in paid work is an important aspect of daily life and a key life role for Australian adults. People with upper limb loss (ULL) resulting from amputation or limb deficiency may face particular challenges in initiating or maintaining their work activities and roles, however this has received limited attention in the amputee-related literature to date. This study aimed to (a) describe the demographic, limb loss and employment-related characteristics of people attending one Victorian Upper Limb Amputee Clinic and (b) to explore what people living with ULL perceive as the factors influencing their work participation. A mixed methods approach was employed within a grounded theory framework. Fifty-five adults with ULL responded to a questionnaire about work participation. A subset of 13 questionnaire respondents participated in in-depth interviews to further explore their work experiences. Analysis of survey findings revealed that the study sample had similar characteristics to other groups of people with ULL described in international amputee literature. The majority of those who were less than working age at the time of ULL experienced paid work in adulthood, and 62% of those who were of working age at the time of ULL returned to work. A journeying metaphor was used to describe the experience of initiating participation in work with ULL and a range of factors were identified that influenced an individual’s experience. These included the impact of ongoing physical and psychological issues, perceived negative employer attitude, appropriate matching between job demands and capacity, use of strategies to minimise difference in appearance, and the support available through peers and informal networks. These findings highlight the complexity faced by people with ULL when attempting to initiate participation in paid work. Findings have applicability for people with ULL and health and vocational professionals, as well as funders, policy developers and service planners.