Perceptions of People With Tetraplegia Regarding Surgery to Improve Upper-Extremity Function

Wagner, Jared P.; Curtin, Catherine; Gater, David R.; Chung, Kevin C.

doi:10.1016/j.jhsa.2007.01.015

Cited by 45 publications

(26 citation statements)

References 27 publications

(29 reference statements)

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“…Third, to minimize response and scoring burden, the survey focuses on types of expectations and the amount of improvement expected and does not address Our study showed that patients have a characteristic set of expectations that encompass improvement along major categories of pain, physical symptoms, restoration of function, achievement of activity-related goals, and improvement in psychosocial well-being. Numerous studies assessing patients' perspectives of hand and upper extremity conditions have been published [4,8,17,25,30,34], most of which target expectations involving nerve-related disorders [4,17,30,34]. Most recently, Squitieri et al [30] reported results of their pilot study on expectations of treatment in adolescents with neonatal brachial plexus palsy.…”

Section: Discussionmentioning

confidence: 99%

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Kang

Hashmi

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge. Questions/purposes We asked: (1) Do patients with thumb CMC arthritis express characteristic expectations that are quantifiable and have measurable frequency? (2) Can a survey on expectations developed from patientderived data quantitate expectations in patients with thumb CMC arthritis? Methods The study was a prospective cohort study. The first phase was a 12-month-period involving interviews of 42 patients with thumb CMC arthritis to define their expectations of treatment. The interview process used techniques and principles of qualitative methodology including open-ended interview questions, unrestricted time, and study size determined by data saturation. Verbatim responses provided content for the draft survey. The second phase was a 12-month period assessing the survey for test-retest reliability with the recruitment of 36 participants who completed the survey twice. The survey was finalized from clinically relevant content, frequency of endorsement, weighted kappa values for concordance of responses, and intraclass coefficient and Cronbach's alpha for interrater reliability and internal consistency. Results Thirty-two patients volunteered 256 characteristic expectations, which consisted of 21 discrete categories. Expectations with similar concepts were combined by eliminating redundancy while maintaining original terminology. These were reduced to 19 items that comprised a one-page survey. This survey showed high concordance, interrater reliability, and internal consistency, with weighted kappa values between 0.58 and 0.78 (95% CI, 0.39-0.78; p \ 0.001); intraclass correlation coefficient of 0.94 (95% CI, 0.94-0.98; p\0.001), and Cronbach's alpha values of 0.94 and 0.95 (95% CI, 0.91-0.

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Section: Discussionmentioning

confidence: 99%

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Kang

Hashmi

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Focusing on patient-led forums may have particular merit considering the study by Wagner et al that found patients trusted UER if they learned about it from a fellow patient, and aligns with participants’ preference to speak with other surgical patients prior to reconstruction. 36 However, implementation must be thoughtful to overcome some patients’ lower trust of online materials. Video-chatting could be an area of expansion.…”

Section: Discussionmentioning

confidence: 99%

Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia

Harris

Muller

Shauver

et al. 2017

The Journal of Hand Surgery

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Purpose Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that Upper Extremity Reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. Methods Nineteen patients with C4-C8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semi-structured interviews were conducted and transcripts evaluated using grounded theory methodology. Results Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: 1) functional dissatisfaction 2) awareness of UER and 3) acceptance of surgery. Patients’ ability to meet these criteria was determined by three checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. Conclusions We built a conceptual model that outlines how patients’ personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. Clinical Relevance To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.

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“…[70][71][72] It allows the tetraplegic patient some autonomy, permitting completion of some personal activities of daily living (ADLs) independently or with the aid of appliances. [70][71][72] It allows the tetraplegic patient some autonomy, permitting completion of some personal activities of daily living (ADLs) independently or with the aid of appliances.…”

Section: Tetraplegiamentioning

confidence: 99%

Tendon transfers

Gascoigne

Flood

2015

Plastic and Reconstructive Surgery

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Perceptions of People With Tetraplegia Regarding Surgery to Improve Upper-Extremity Function

Cited by 45 publications

References 27 publications

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia

Tendon transfers

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