Development of a Questionnaire to Measure Impact and Outcomes of Brachial Plexus Injury

Mancuso, Carol A.; Lee, Steve K.; Saltzman, Eliana B.; Model, Zina; Landers, Zoe A.; Dy, Christopher J.; Wolfe, Scott W.

doi:10.2106/jbjs.17.00497

Cited by 13 publications

(7 citation statements)

References 20 publications

(38 reference statements)

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“…These instruments successfully document, qualify, and quantify expectations pre-surgery and fulfillment of expectations post-surgery. [24][25][26]30,36,37 Our finding that patients in the higher quartiles of expectations had greater impairment levels on the PRWE compared with the lowest quartile is also consistent with surgical expectations for other diagnostic groups. 37,38…”

Section: Discussionsupporting

confidence: 81%

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery

et al. 2022

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Background The purpose of this study was to develop and test a patient-derived expectations survey for wrist arthritis surgery. We hypothesized that preoperative patient expectations are higher in people with greater functional impairment and that postoperative fulfilment of patient expectations correlates with functional improvement. Methods The study was conducted in four phases. Development (n = 22) Preoperatively, patients were asked open-ended questions regarding expectations of surgery. A draft survey was then assembled. Reliability (n = 35) The survey was administered twice preoperatively. Concordance was measured with weighted kappa values and intraclass correlations (ICC). Validity (n = 58) Validity was assessed by comparing responses from the Expectations Survey to the patient-rated wrist evaluation (PRWE). Responsiveness (n = 18) Responsiveness was calculated by comparing the proportion of expectations fulfilled to PRWE scores 1-year postoperatively. Results Development Twenty-two distinct items representing the most frequent responses were utilized from the draft survey items of 1,244 expectations volunteered. Reliability Patients had high preoperative expectations of surgery (mean = 76.8); 30% had scores ≥90. Test–retest reliability was high (Cronbach α coefficients = 0.91, 0.93, ICC = 0.86). Endorsement of items = 66 to 100%; and weighted kappa values = 0.39 to 0.96. Validity Patients with greater preoperative expectations (≥63) had more pain, worse function, and worse PRWE scores than those with lower expectations. Responsiveness The proportion of fulfilled expectations was high (mean 0.80, median 0.79), and greater fulfillment (proportion > 0.80, n = 8) was associated with better postoperative PRWE scores. Conclusion The patient-derived expectations survey is reliable, valid, responsive, and addresses a spectrum of expectations for patients undergoing surgery for wrist arthritis.Clinical relevance Understanding patient expectations can contribute to customized care given the range of surgical choices for the arthritic wrist.

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Section: Discussionsupporting

confidence: 81%

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery

et al. 2022

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“…The interview guide included questions oriented towards changes in their physical limitations, emotional recovery, and social relationships. The interview guide covered multiple domains of recovery after BPI, as previously reported by Mancuso et al: 11 pain, function, independence, limitations, appearance, finances, employment, and mood.…”

Section: Methodsmentioning

confidence: 99%

A qualitative study of life satisfaction after surgery for adult traumatic brachial plexus injury

Brogan

Rolf

et al. 2021

Bone & Joint Open

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Aims Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care. Methods We conducted semi-structured interviews with 15 BPI patients after initial nerve reconstruction. The interview guide was focused on the patient’s experience after BPI, beginning with the injury itself and extending beyond surgical reconstruction. Inductive and deductive thematic analysis was used according to standard qualitative methodology to better understand overall life satisfaction after BPI, contributors to life satisfaction, and opportunities for improvement. Results Among the 15 patients interviewed, the following themes emerged: 1) happiness and life satisfaction were noted despite limitations in physical function; 2) quality of social support influences life satisfaction during recovery from BPI; and 3) social participation and having a sense of purpose impact life satisfaction during recovery from BPI. Conclusion How patients perceive their BPI treatment and recovery varies widely, and is not directly linked to their self-reported functional outcome. Patients with stronger social circles and activities that give them a sense of fulfillment were more likely to be satisfied with their current status. Evaluating a patient’s social network, goals, and potential supportive adaptations early in the treatment timeline through coordinated multidisciplinary care may improve overall satisfaction during recovery from BPI. Cite this article: Bone Joint Open 2020;2(1):9–15.

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“…18 Additional investigation incorporating preoperative patient expectations and patient-reported outcomes for BPI is needed. 19 Implementation of standardized measures with a large sample size that encompasses the wide variety of injury severity will provide guidance for BPI surgeons to counsel patients regarding what to expect from both functional and psychological perspectives.…”

Section: Discussionmentioning

confidence: 99%

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury

Brogan

Rolf

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons’ perspectives on the care of BPI patients and potential areas for improvement in care delivery. Methods: We conducted semistructured qualitative interviews with 14 surgeons with expertise in BPI reconstruction. The interview guide contained questions regarding the surgeons’ practice and care team structure, their attitudes and approaches to psychological and emotional aspects of recovery, and their preferences for setting patient expectations. We used inductive thematic analysis to identify themes. Results: There was a high degree of variability in how surgeons addressed emotional and psychological aspects of recovery. Whereas some surgeons embraced the practice of addressing these components of care, others felt strongly that BPI surgeons should remain focused on technical aspects of care. Several participants described the emotional toll that caring for BPI patients can have on surgeons and how this concern has affected their approach to care. Surgeons also recognized the importance of setting preoperative expectations. There was an emphasis on setting low expectations in an attempt to minimize the risk for dissatisfaction. Surgeons described the challenges in effectively counseling patients about a condition that is prone to substantial injury heterogeneity and variability in functional outcomes. Conclusions: Our results demonstrate wide variability in how surgeons address emotional, psychological, and social barriers to recovery for BPI patients. Clinical relevance: Best practices for BPI care are difficult to establish because of the relative heterogeneity of neurologic injury, the unpredictable impact and recovery of the patient, and the substantial variability in physician approach to the care of these patients.

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Development of a Questionnaire to Measure Impact and Outcomes of Brachial Plexus Injury

Cited by 13 publications

References 20 publications

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery

A qualitative study of life satisfaction after surgery for adult traumatic brachial plexus injury

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury

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