Abstract
Background
Tendon transfer surgery can effectively improve hand function for patients with tetraplegia
but remains poorly utilized. Little is known regarding how patients’ rehabilitation
experiences influence their perception of function, identity, and coping to shape
their reconstructive context.
Methods
We performed a cross-sectional qualitative analysis of 19 participants with C4–C7
cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured
interviews were conducted using an interview guide focusing on rehabilitation experience,
the relationship between function and identity, and how patient experience evolved.
Interview transcripts were analyzed using grounded theory.
Results
The study sample was predominantly male (79%), white (89%), and American Spinal Injury
Association grades A–D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing
rehabilitation's necessity, functional gains, and constructive patient–therapist relationships
promoted engagement in therapy. Poor insurance coverage and financial constraints
decreased rehabilitation access. Function affected identity through the degree to
which it tied participants to a “patient” role. Early in recovery, patients’ function,
roles, and attitudes were fluid but solidified over time; how satisfied patients were
with these final positions influenced how they coped.
Conclusion
The balance of patients’ positive and negative coping has been found to influence
patients’ progression to surgery. This study describes how function and identity contribute
to coping. Participants’ function and identity evolved during a finite period we call
“the golden year,” before reaching a fixed point around which they built their lives.
The norms patients establish during this time may affect receptiveness to surgery.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management guidelines for penetrating abdominal trauma.World J Surg. 2015; 39: 1373-1380
- Western Trauma Association critical decisions in trauma: diagnosis and management of esophageal injuries.J Trauma Acute Care Surg. 2015; 79: 1089-1095
- Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma.J Trauma. 2011; 70: 1551-1556
- Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II.J Trauma Acute Care Surg. 2013; 75: 391-397
- Sexual loss in relation to other functional losses for spinal cord injured males.Arch Phys Med Rehabil. 1976; 57: 291-293
- Components of quality of life for persons with a quadriplegic and paraplegic spinal cord injury.Qualitat Health Res. 2001; 11: 795-811
- Predictors of life satisfaction: a spinal cord injury cohort study.Arch Phys Med Rehabil. 2002; 83: 555-561
- Targeting recovery: priorities of the spinal cord-injured population.J Neurotrauma. 2004; 21: 1371-1383
- Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics.Spinal Cord. 2004; 42: 526-532
- Tendon transfers to improve grasp in patients with cervical spinal cord injury.Paraplegia. 1975; 13: 15-24
- Upper limb reconstruction in quadriplegia: Functional assessment and proposed treatment modifications.J Hand Surg. 1983; 8: 119-131
- Improvements in activities of daily living following functional hand surgery for treatment of lesions to the cervical spinal cord: self-assessment by patients.Spinal Cord. 2002; 40: 574-580
- The role of upper limb surgery in tetraplegia.Spinal Cord. 2003; 41: 90-96
- Satisfaction with upper-extremity surgery in individuals with tetraplegia 1, 2.Arch Phys Med Rehabil. 2003; 84: 1145-1149
- Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia.J Hand Surg Eur Vol. 2010; 35: 563-568
- Long-term patient satisfaction after reconstructive upper extremity surgery to improve arm-hand function in tetraplegia.Spinal Cord. 2011; 49: 903-908
- Satisfaction with upper extremity surgery in individuals with tetraplegia.J Spinal Cord Med. 2015; 38: 161-169
- Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Principles and preliminary experience.J Bone Joint Surg Am. 1975; 57: 196-206
- Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study.J Hand Surg. 2005; 30: 94-99
- Recent demographic and injury trends in people served by the model spinal cord injury care systems.Arch Phys Med Rehabil. 1999; 80: 1372-1382
- Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems.Spinal Cord. 2004; 42: 169-176
- Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function.J Hand Surg. 2007; 32: 483-490
- Importance of access to research information among individuals with spinal cord injury: results of an evidenced-based questionnaire.Spinal Cord. 2002; 40: 529-535
- Physician perceptions of upper extremity reconstruction for the person with tetraplegia.J Hand Surg. 2005; 30: 87-93
- Issues influencing the decision to have upper limb surgery for people with tetraplegia.Spinal Cord. 2012; 50: 844-847
- Decision-making about upper limb tendon transfer surgery by people with tetraplegia for more than 10 years.Arch Phys Med Rehabil. 2016; 97: S88-S96
- The battle between hoping and suffering: a conceptual model of hope within a context of spinal cord injury.Adv Nurs Sci. 2008; 31: 237-248
- Understanding and overcoming barriers to upper limb surgical reconstruction after tetraplegia: the need for interdisciplinary collaboration.Arch Phys Med Rehabil. 2016; 97: S81-S87
- Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory.Disabil Rehabil. 2013; 35: 1293-1301
- Checkpoints to progression: qualitative analysis of the personal and contextual factors that influence selection of upper extremity reconstruction among patients with tetraplegia.J Hand Surg Am. 2017; 42 (495-505.e11. PubMed PMID: 28669418; NIHMSID: NIHMS928110; PubMed Central PMCID: PMC5753404.)
- COREQ (Consolidated Criteria for Reporting Qualitative Studies).Guidelines for reporting health research: a user's manual. John Wiley & Sons, Ltd, Hoboken (NJ)2014: 214-226
- Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Int J Qual Health Care. 2007; 19: 349-357
- Qualitative methods in public health: a field guide for applied research.2nd ed. Wiley, San Francisco2016
- A guide to qualitative research in plastic surgery.Plastic Reconstruct Surg. 2010; 126: 1089-1097
- Qualitative interview design: a practical guide for novice investigators.Qualitat Rep. 2010; 15: 754
- A purposeful approach to the constant comparative method in the analysis of qualitative interviews.Qual Quant. 2002; 36: 391-409
- Coping and adaptation following acute spinal cord injury: a theoretical analysis.Paraplegia. 1980; 18: 74-85
- What promotes physical activity after spinal cord injury? An interview study from a patient perspective.Disabil Rehabil. 2006; 28: 481-488
- Rehabilitation and future participation of youth following spinal cord injury: caregiver perspectives.Spinal Cord. 2009; 47: 882-886
- An economical and proved helicopter program for transporting the emergency critically ill and injured patient in Maryland.J Trauma. 1973; 13: 1029-1038
- Leveraging the medical context to increase upper extremity reconstruction among patients with tetraplegia: a qualitative analysis.Arch Phys Med Rehabil. 2018; 99: 459-467
- Tendon transfer surgery for people with tetraplegia: an overview.Arch Phys Med Rehabil. 2016; 97: S75-S80
National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2018.
Article info
Publication history
Published online: August 30, 2018
Accepted:
July 9,
2018
Received in revised form:
May 8,
2018
Received:
January 15,
2018
Footnotes
The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by T32 Training Grant (5T32GM008616-17).
Presented at the Dr. Robert Buxton Research Symposium, University of Maryland, Baltimore, MD, June 2107; and the 2018 Academic Surgical Congress in Tampa, FL, February 5–8, 2018.
Identification
Copyright
Published by Elsevier Inc.
