Employment status of powered wheeled and seated mobility device users: a meta-analysis and systematic review

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Abstract
Employment determinants remain a critical yet under-researched factor in the social participation and inclusion of individuals with mobility impairments who use powered mobility devices (PWSMD). This systematic review and individual participant data meta-analysis aims to evaluate employment rates and identify factors influencing employment among PWSMD users. One- and two-stage meta-analyses were conducted, assessing employment status in relation to demographic, health-related and environmental factors. Random-effects models were used to account for between-study heterogeneity. Quality assessment was performed with tools for evidence synthesis provided by Joanna Briggs Institute (JBI). The PRISMA criteria were followed in the review. A systematic search of CINAHL, Embase, Cochrane, PubMed, Scopus and Web of Science databases conducted up to February 2025 identified 19 eligible studies encompassing 443 participants. 46.6% of participants were working at higher rates associated with tertiary education, pre-existing employment, vocational rehabilitation and PWSMD use of more than 10 years. Higher employment rates were also observed in participants younger than 60 years and those with childhood onset disability. No significant correlations were observed with sex, marital status, or residential setting. Higher levels of education, longer duration of PWSMD use, younger age, pre-existing employment and participation in vocational rehabilitation are associated with an increased likelihood of employment among PWSMD users. Sex, marital status and settlement type may not have an impact on employment. Further research is needed to determine most beneficial aspects of vocational rehabilitation and to explore the relationship between disability duration and employment in specific diagnostic groups.

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