Abstract
Objectives
To (1) characterize patients' medical experiences from initial injury until they become
candidates for upper extremity reconstruction (UER); and (2) identify points in this
medical context that may be most amenable to interventions designed to increase UER
utilization.
Design
A qualitative cross-sectional study using grounded theory methodology and constant
comparative analysis of data collected through semistructured individual interviews.
Setting
Community.
Participants
A sample of individuals with C4 to C8 cervical spinal injuries (N=19) who sustained
injuries at least 1 year before interview. Nine patients had undergone reconstruction,
and 10 had not. The study sample was predominantly male (79%) and white (89%), and
American Spinal Injury Association grades A through D were represented (A, 42%; B,
32%; C, 16%; D, 10%).
Interventions
Not applicable.
Main Outcome Measures
Participants' self-report of their medical experiences from the time of injury through
the early recovery period.
Results
We identified 3 domains that formed patients' medical context before UER candidacy:
(1) their ability to achieve and maintain health; (2) their relationship with health
care providers; and (3) their expectations regarding clinicians' tetraplegia-specific
expertise. Trust emerged as a major theme driving potential intervention targets.
Patients transferred to referral centers had higher trust in tertiary providers relative
to local physicians. In the outpatient setting, patients' trust correlated with the
tetraplegia-specific expertise level they perceived the specialty to have (high for
physical medicine and rehabilitation, intermediate for urology, low for primary care).
Conclusions
In appropriate candidates, UER produces substantial functional gains, but reconstruction
remains underused in the tetraplegic population. By analyzing how patients achieve
health and build trust in early recovery/injury, our study provides strategies to
improve UER access. We propose that interventions targeting highly trusted points
of care (transfer hospitals) and avoiding low-trust points (primary care physicians,
home health) will be most effective. Urology may represent a novel entry point for
UER interventions.
Keywords
List of abbreviations:
PM&R (physical medicine and rehabilitation), SCI (spinal cord injury), UER (upper extremity reconstruction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 03, 2017
Footnotes
Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award no. 2 K24-AR053120-06). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
