Abstract
Study design:
Survey.
Objectives:
To determine whether upper extremity reconstruction in patients with tetraplegia is underutilized internationally and, if so, what are the barriers to care.
Setting:
International—attendees of a meeting in Paris, France.
Methods:
One hundred and seventy attendees at the Tetrahand meeting in Paris in 2010 were sent a 13-question survey to determine the access and utilization of upper limb reconstruction in tetraplegic patients in their practice.
Results:
Respondents ranged the globe including North America, South America, Europe, Asia and Australia. Fifty-nine percent of respondents had been practicing for more than 10 years. Sixty-four percent of respondents felt that at least 25% of people with tetraplegia would be candidates for surgery. Yet the majority of respondents found that <15% of potential patients underwent upper extremity reconstruction. Throughout the world direct patient referral was the main avenue of surgeons meeting patients with peer networking a distant second. Designated as the top three barriers to this care were lack of knowledge of surgical options by patients, lack of desire for surgery and poor referral patterns to appropriate upper extremity surgeons.
Conclusion:
The results of this survey, of a worldwide audience, indicate that many of the same barriers to care exist regardless of the patient’s address. This was a preliminary opinion survey and thus the results are subjective. However, these results provide a roadmap to improving access to care by improving patient education and interdisciplinary physician communication.
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References
Simpson LA, Eng JJ, Hsieh JT, Wolfe DL . The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma 2012; 29: 1548–1555.
Putzke JD, Richards JS, Hicken BL, DeVivo MJ . Predictors of life satisfaction: a spinal cord injury cohort study. Arch Phys Med Rehabil 2002; 83: 555–561.
van Leeuwen CM, Post MW, Hoekstra T, van der Woude LH, de Groot S, Snoek GJ et al. Trajectories in the course of life satisfaction after spinal cord injury: identification and predictors. Arch Phys Med Rehabil 2011; 92: 207–213.
Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F . 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.
Anderson KD . Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21: 1371–1383.
Jaspers Focks-Feenstra JH, Snoek GJ, Bongers-Janssen HM, Nene AV . Long-term patient satisfaction after reconstructive upper extremity surgery to improve arm-hand function in tetraplegia. Spinal Cord 2011; 49: 903–908.
Wangdell J, Friden J . Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia. J Hand Surg Eur Vol 2010; 35: 563–568.
Curtin CM, Gater DR, Chung KC . Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg Am 2005; 30: 94–99.
Curtin CM, Wagner JP, Gater DR, Chung KC . Opinions on the treatment of people with tetraplegia: contrasting perceptions of physiatrists and hand surgeons. J Spinal Cord Med 2007; 30: 256–262.
Wagner JP, Curtin CM, Gater DR, Chung KC . Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function. J Hand Surg Am 2007; 32: 483–490.
Anderson KD, Friden J, Lieber RL . Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord 2009; 47: 334–338.
Matter B, Feinberg M, Schomer K, Harniss M, Brown P, Johnson K . Information needs of people with spinal cord injuries. J Spinal Cord Med 2009; 32: 545–554.
Hansberry DR, Agarwal N, Shah R, Schmitt PJ, Baredes S, Setzen M et al. Analysis of the readability of patient education materials from surgical subspecialties. The Laryngoscope 2014; 124: 405–412.
Cene CW, Dewalt DA . Left behind: ensuring clarity and completeness of our educational materials and messages. JAMA Intern Med 2013; 173: 583–584.
Paralyzed Veterans of America Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2005; 28: 434–470.
Divanoglou A, Westgren N, Seiger A, Hulting C, Levi R . Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study. J Spinal Cord Med 2010; 33: 117–127.
Divanoglou A, Seiger A, Levi R . Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study. Spinal Cord 2010; 48: 477–482.
Divanoglou A, Westgren N, Bjelak S, Levi R . Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study. Spinal Cord 2010; 48: 470–476.
Divanoglou A, Levi R . Incidence of traumatic spinal cord injury in Thessaloniki, Greece and Stockholm, Sweden: a prospective population-based study. Spinal Cord 2009; 47: 796–801.
Bryden AM, Wuolle KS, Murray PK, Peckham PH . 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.
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Fox, P., Suarez, P., Hentz, V. et al. Access to surgical upper extremity care for people with tetraplegia: an international perspective. Spinal Cord 53, 302–305 (2015). https://doi.org/10.1038/sc.2015.3
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DOI: https://doi.org/10.1038/sc.2015.3
