The golden year: How functional recovery sets the stage for tendon transfer surgery among patients with tetraplegia—a qualitative analysis

Surgery, 2019 · DOI: 10.1016/j.surg.2018.07.009 · Published: February 1, 2019

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

This study explores how patients with tetraplegia experience rehabilitation and how it shapes their view of their function, identity, and ability to cope, which influences their decision-making about tendon transfer surgery. The research found that patients' function and identity evolve during a specific period called the 'golden year,' after which they establish fixed routines and beliefs that affect their openness to surgery. The study highlights the importance of early rehabilitation and addressing financial barriers to improve patients' function and promote a positive identity, which can make them more receptive to surgery.

Study Duration

August to September 2016

Participants

19 participants with C4–C7 cervical spinal injuries: 9 had reconstruction; 10 had not

Evidence Level

Not specified

Key Findings

1
Engagement in therapy was promoted by recognizing its necessity, achieving functional gains, and developing constructive patient-therapist relationships.
2
Poor insurance coverage and financial constraints decreased rehabilitation access, hindering functional improvement.
3
Function affected identity through the degree to which it tied participants to a 'patient' role, impacting their sense of autonomy and roles in family and community.

Research Summary

This qualitative study explored how rehabilitation experiences influence patients' perceptions of function, identity, and coping in the context of tendon transfer surgery for tetraplegia. The study identified factors such as access to rehabilitation, patient-therapist relationships, and financial constraints as key influences on functional recovery and its impact on patient identity. The concept of a 'golden year' was introduced, suggesting a critical period during which function and identity evolve before stabilizing, affecting receptiveness to surgery.

Practical Implications

Early Intervention

Introducing reconstruction options early, during the 'golden year,' can help patients calibrate their recovery expectations.

Address Financial Barriers

Improving insurance coverage and addressing financial constraints can enhance rehabilitation access and functional outcomes.

Holistic Approach

A holistic approach that considers the interplay between function, identity, and coping is crucial in managing tetraplegia patients' care.

Study Limitations

1
Participants were recruited primarily from a single geographic region and were predominantly white men.
2
The surgical and nonsurgical groups were not identical, with imbalances in injury level, education, and gender.
3
The study relied on patient self-report of function rather than empiric measurements.

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