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

Abstract

Study design:A questionnaire-based survey.Objectives:To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire.Setting:A center for advanced reconstruction of extremities, Gothenburg, Sweden.Methods:Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling.Results:Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test–retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities.Conclusion:Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.

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

“…The study cohort includes 15 women (26%), with a mean age of 49 years (range: 24-77) and 42 men (74%), with a mean age of 46 years (range: 23-78) and is previously presented in detail. 18 The mean age at the time of surgery was 41 years (range: 20-73), and the average number of years elapsed since the surgery was six (range: 2-11). The average number of years elapsed between the injury and the first surgery in the study cohort was six (range: 1-16).…”

“…The questionnaire is shown to be reliable both by test-retest analysis and by measurement of its internal consistency. 18 Self-rated health was measured using the Visual Analogue Scale (VAS) included in the EuroQol five-dimension questionnaire-3L (EQ-5D-3L) that generates information concerning the respondents' perceived overall healthrelated quality of life. The respondent is asked to mark his/her health status on a 20 cm vertical scale with endpoints of 0 and 100, the endpoints being labeled 'the best health you can imagine' and 'the worst health you can imagine'.…”

“…The results from the satisfaction survey as a whole have previously been described in detail. 18 The participants' answers to the open questions (part 3) were used in the present study, and were linked to the ICF model as recommended by Sinnott et al 7,8 In total, 49 participants (86%) mentioned activities in which their function was improved after surgery. In Figure 2, satisfactory gains reported by the participants after upper-limb tetraplegia surgery are applied to the ICF constructs, body function/structures and activity.…”

“…In order to determine long-term satisfaction after reconstructive upper-limb tetraplegia surgery, a questionnaire-based survey in a Swedish study cohort has previously been conducted. 18 The average time elapsed since surgery was 6 years (range = 1-11). The participants' responses to the questions in the following three categories: satisfaction, activities and employment/education were positive in 83, 72 and 31%, respectively.…”

“…[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. [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.…”