Leveraging the Medical Context to Increase Upper Extremity Reconstruction among Patients with Tetraplegia: A Qualitative Analysis

Arch Phys Med Rehabil, 2018 · DOI: 10.1016/j.apmr.2017.06.028 · Published: March 1, 2018

Spinal Cord Injury Orthopedics Research Methodology & Design

Simple Explanation

This research explores the factors influencing the decision to undergo Upper Extremity Reconstruction (UER) among individuals with tetraplegia, focusing on their experiences from initial injury through early recovery. The study identifies key points in patients' medical journeys where interventions could effectively increase the utilization of UER, aiming to improve access to this potentially beneficial surgery. Trust in healthcare providers emerged as a critical theme, with the study suggesting that building trust early in the recovery process, particularly at referral hospitals, could positively impact UER consideration.

Study Duration

August-September 2016

Participants

19 individuals with C4–C8 cervical spinal injuries

Evidence Level

Qualitative cross-sectional study

Key Findings

1
Patients' medical context prior to UER candidacy is shaped by their ability to achieve and maintain health, their relationship with healthcare providers, and their expectations regarding clinicians’ tetraplegia-specific expertise.
2
Trust in healthcare providers is a major factor influencing patients' willingness to consider UER, with patients at referral centers having higher trust in tertiary providers relative to local physicians.
3
Patients have varying expectations of tetraplegia-specific expertise depending on the provider specialty, with higher expectations for specialists like urologists compared to primary care physicians.

Research Summary

This qualitative study investigates the medical experiences of tetraplegic patients from initial injury to UER candidacy to identify opportunities for increasing UER utilization. The study highlights the importance of trust in healthcare providers, particularly those at referral centers, and the need for interventions targeting highly trusted points of care. The findings suggest that urology may represent a novel entry point for UER interventions, given patients' expectations of tetraplegia-specific expertise in this specialty.

Practical Implications

Targeted Interventions

Focus interventions on highly trusted points of care, such as transfer hospitals, to improve UER access and awareness.

Specialty-Specific Education

Provide tetraplegia-specific education and resources to urologists and their clinics to increase UER awareness within this patient population.

Trust Building

Healthcare providers should prioritize building trust with patients early in the recovery process to positively influence their UER decision-making.

Study Limitations

1
Retrospective nature may color patient reports of initial experiences.
2
Findings may not be transferable due to the predominantly white sample from a single geographic area.
3
The study did not independently verify cases where patients reported poor care.

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