Satisfaction with upper extremity surgery in individuals with tetraplegia

Abstract

Objective: To supplement the scant information available regarding the satisfaction of patients with tetraplegia following upper extremity reconstructive surgery for such individuals with spinal cord injury (SCI). Study design: Retrospective study with questionnaire follow-up. Setting: The Danish Spinal Cord Injury Centers. Material and methods: In the initial review period, 119 upper extremity surgeries were performed on patients with tetraplegia (n = 49). Seven died and the remaining 42 were invited to complete a follow-up questionnaire with a five-level scale ranging from strongly agree to strongly disagree regarding satisfaction. Forty patients completed the questionnaire. Results: Median time from first surgery was 13 years (2-36). Sixty-five percent of the sample had a C5-C6 SCI, with 64% experiencing complete injury. Initially, 76% of the sample expressed general satisfaction with life, but only 28% of the sample reported that hand appearance improved after surgery. Interestingly, those having surgery from 1991 to 2008 reported significantly greater satisfaction (P < 0.001) and were significantly more satisfied with activities of daily living (ADL) (P < 0.001) than those having surgery between the years 1973 and 1990. In particular, gain of independence was obtained with pinch/specific hand surgery compared to triceps activation. Accordingly, the pinch/specific hand surgery group was significantly more satisfied than the triceps group on the ADL (P = 0.027), and the independence questions (P < 0.001). Conclusion: Overall satisfaction with upper extremity surgery is high. It can have a positive impact on life in general, ability to perform ADL, as well as supplying an increased level of independence.

Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire

“…The activities in which participants' function was improved after surgery were similar to the activities mentioned in the Danish study by Gregersen et al 19 …”

Essential gains and health after upper-limb tetraplegia surgery identified by the International classification of functioning, disability and health (ICF)

“…These results are in accordance with the findings of previous studies linking Upperlimb surgery to ICF domains. 4,14,29 Clearly, patients' perception of satisfaction after upper-limb tetraplegia surgery is very high, [18][19][20][21] and the gains could be linked to the ICF categories body functions/ structures and activity. The more active joints a person has, the better the ability to grasp, release and manipulate an object.…”

“…Ninety-five percent responded that the surgery had been beneficial, which is similar, albeit slightly higher as compared with previous studies conducted in the United States, the Netherlands and Denmark, where the proportion of positive responses ranged between 80 and 90%. [19][20][21] In the Swedish satisfaction survey, it was concluded that surgical interventions are rewarding from a patient perspective, because they lead to improvements in daily life as well as enhanced quality of life. 18 None of the previous satisfaction surveys conducted in the United States, the Netherlands and Denmark have used the ICF to interpret the results.…”

“…18 None of the previous satisfaction surveys conducted in the United States, the Netherlands and Denmark have used the ICF to interpret the results. [19][20][21] The choice of surgical procedures depends on the available donor muscle strength according to the Medial Research Council grading system and the International Classification of Surgery of the Hand in Tetraplegia. 1,22 The strength of the available donor muscles is considered to be an important determinant of the success of tetraplegia upper-limb surgery.…”

Reach and Palmar Grasp in Tetraplegics With Neuromuscular Electrical Stimulation

“…In the cervical spinal cord injuries, impaired arm and hand function is straight connected to the loss of functional independence level in quadriplegics 1 and recovery of Upper Limb (UL) movements is essential for the rehabilitation of these individuals. Several therapeutic interventions are used, in an attempt to improve the sensory and motor deficits, such as tendons transfers, orthosis and Neuromuscular Electrical Stimulation (NMES) 1,2 .…”