Access to surgical upper extremity care for people with tetraplegia: an international perspective

Abstract

Study design: Survey. Objectives: To determine whether upper extremity reconstruction in patients with tetraplegia is underutilized internationally and, if so, what are the barriers to care. Setting: International-attendees of a meeting in Paris, France. Methods: One hundred and seventy attendees at the Tetrahand meeting in Paris in 2010 were sent a 13-question survey to determine the access and utilization of upper limb reconstruction in tetraplegic patients in their practice. Results: Respondents ranged the globe including North America, South America, Europe, Asia and Australia. Fifty-nine percent of respondents had been practicing for more than 10 years. Sixty-four percent of respondents felt that at least 25% of people with tetraplegia would be candidates for surgery. Yet the majority of respondents found that o15% of potential patients underwent upper extremity reconstruction. Throughout the world direct patient referral was the main avenue of surgeons meeting patients with peer networking a distant second. Designated as the top three barriers to this care were lack of knowledge of surgical options by patients, lack of desire for surgery and poor referral patterns to appropriate upper extremity surgeons. Conclusion:The results of this survey, of a worldwide audience, indicate that many of the same barriers to care exist regardless of the patient's address. This was a preliminary opinion survey and thus the results are subjective. However, these results provide a roadmap to improving access to care by improving patient education and interdisciplinary physician communication.

Nerve Transfer Surgery in Spinal Cord Injury: Online Information Sharing

“…Of the 27 recommendations made for specialties and specialists offering nerve transfer, only two posts in our study recommended a plastic surgeon, despite plastic surgeons being on the forefront of nerve transfer surgery and peripheral nerve research. 7,13 Similar biases can be introduced in the discussion of medical centers. In response to a post about a speci c center performing nerve transfer, one commenter made plans to travel out-of-state to receive a consult, believing this was a unique opportunity unavailable elsewhere.…”

“…[7][8][9][10] Although studies have shown signi cant gains in upper extremity range of motion and strength after nerve transfer 11,12 , use of upper extremity reconstruction remains low around the world. 13,14 One barrier which may contribute to low utilization rates is lack of awareness in the SCI community of surgical options to improve upper extremity function. 15 To address this lack of knowledge, it is important to identify where individuals seek information on treatment options, and what information is available.…”

Rehabilitation After Surgical Reconstruction to Restore Function to the Upper Limb in Tetraplegia: A Changing Landscape

“…Previous studies have reported an underutilization of surgeries to restore upper limb function in tetraplegia. 17,18 That is, individuals who are candidates to receive surgery do not undergo the procedure. Two articles in the supplement direct attention to eliminating unnecessary barriers in the delivery of care and empowering patients to make informed choices.…”

Surgery to restore upper extremity function in tetraplegia—Preferences for early and frequent access to information

“…Improving upper extremity (UE) function is a high priority for people living with cervical spinal cord injury (SCI). [1][2][3][4][5] Improved UE function increases independence 6,7 and may reduce health care costs. Surgical interventions such as UE nerve [8][9][10][11][12][13][14] and tendon transfers 15 may supplement comprehensive rehabilitation and provide a path toward the return of UE function.…”

“…In the SCI community, there is limited awareness that UE surgery is an option to enhance hand function. 3,17 Others may have difficulty finding and understanding inaccessible and complex health information, physically accessing resources, 17 navigating health care systems, 4 or are not referred to UE surgeons. 3 The variable surgical outcomes after UE surgery in SCI 10,12,18 may have resulted in low adoption of nerve and tendon transfer surgeries; however, recent work supports their benefit.…”