Study design
Systematic scoping review
Objectives
The purpose of this study was to understand the barriers to accessing upper extremity (UE) reconstructive surgery among those living with tetraplegia, and to identify gaps in knowledge.
Methods
Using standardized scoping review methods, a literature search was conducted using four databases and 1069 articles were procured. Two independent reviewers systematically screened the articles in two phases. Retrieved articles underwent thematic analysis using a constructivist grounded theory methodology.
Results
The reviewed articles (n = 25) were published between 2002 and 2019, and study designs included: cross-sectional (64%), retrospective (16%), and review articles (8%). Common barriers to UE reconstruction were categorized into factors related to patients, providers, and systems. These general domains included lack of awareness of UE reconstruction and its benefits among people with tetraplegia and providers, poor interdisciplinary working relationships, and a lack of specialized centers that provide these reconstructive surgeries. Specific patient-related barriers related to intrinsic (coping skills, trust, fear) and extrinsic (support network, finances, postoperative course) factors that influenced decision-making.
Conclusions
There are many barriers that prevent individuals with tetraplegia from accessing surgery at different levels of the healthcare system. Establishing specialized centers with strong interdisciplinary working relationships and raising awareness about the advantages and disadvantages of UE reconstruction through peer networks may help to improve accessibility. Using a value-based, patient-centered approach by exploring how individuals with SCI weigh each decision factor when considering surgery may help providers develop treatment options that better align with their goals.
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Data availability
The dataset analyzed during the current study is available from the corresponding author on reasonable request.
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Acknowledgements
The authors would like to thank the support of the Sunnybrook Health Sciences Centre librarians, who provided us with their expertise during the literature search process.
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CY acquired the data, interpreted the results, drafted and revised the manuscript, and approved the final version. SS acquired the data and edited and approved the final manuscript. CBN is an expert within the field of spinal cord and peripheral nerve surgery; she provided the team with extensive expertise in the area of research design and conduct, edited the manuscript thoroughly, provided feedback on the report, and approved the final version. IKF is an expert in the field of peripheral nerve surgery and provided the team with her expertise, assisted with interpreting the results, and editing the manuscript. JD was the principal investigator, conceived and designed the study, and oversaw every phase of the study from its conception through its completion.
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Yeung, C., Salim, S., Fox, I.K. et al. Identifying barriers to upper extremity reconstruction in tetraplegia: a systematic scoping review. Spinal Cord 59, 1088–1095 (2021). https://doi.org/10.1038/s41393-021-00631-7
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DOI: https://doi.org/10.1038/s41393-021-00631-7
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