Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors that Influence Selection of Upper Extremity Reconstruction among Patients with Tetraplegia

J Hand Surg Am, 2017 · DOI: 10.1016/j.jhsa.2017.04.003 · Published: July 1, 2017

Spinal Cord Injury Orthopedics Research Methodology & Design

Simple Explanation

Patients with tetraplegia prioritize regaining upper extremity function. Upper Extremity Reconstruction (UER) can significantly improve function, but it's underutilized. This study explores patient factors influencing UER decisions. The study involved interviewing 19 patients with cervical spinal injuries, some who had UER and some who hadn't. The goal was to identify common characteristics and checkpoints in the decision-making process. The research identified three key checkpoints: coping with the injury, access to information about UER, and acceptance of surgery. These checkpoints are influenced by personal and contextual factors.

Study Duration

August-September 2016

Participants

19 patients with C4-C8 cervical spinal injuries (9 UER, 10 no UER)

Evidence Level

Qualitative study

Key Findings

1
Patients who undergo UER typically progress through stages of functional dissatisfaction, awareness of UER, and acceptance of surgery.
2
A lack of knowledge regarding reconstruction was identified as the most significant barrier to surgery among the participants.
3
Patients with extreme coping behaviors (very positive or very negative) were less likely to seek or undergo UER.

Research Summary

The study built a conceptual model outlining how personal and contextual factors influence patients' decisions regarding UER. Moving from functional dissatisfaction to awareness of UER was a major hurdle, especially for those with extreme coping skills. The research highlights the importance of increasing awareness of UER to improve its utilization among eligible patients. Interventions are needed to standardize the introduction to UER during rehabilitation or through improved e-content. The study suggests that coping is not a good leverage point to maximize surgical uptake and that attempts to improve coping will be challenging and likely to be inefficient.

Practical Implications

Increase UER Awareness

Standardize introduction to UER during rehabilitation and improve e-content to increase patient awareness.

Targeted Information

Focus on patient-led forums and video-chatting to build trust in UER information.

Physician Buy-In

Encourage PM&R physicians to promote UER, addressing potential discrepancies in beliefs about its benefits.

Study Limitations

1
Lack of objective functional metrics to correlate perceived function with actual function.
2
The study subjects might represent a more proactive cohort than the general SCI population.
3
The sample was predominantly white and from a single geographic location, potentially limiting transferability.

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