Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire

L Bunketorp-Käll, J Wangdell, C Reinholdt, J Fridén, L Bunketorp-Käll, J Wangdell, C Reinholdt, J Fridén

Abstract

Study design: A questionnaire-based survey.

Objectives: To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire.

Setting: A center for advanced reconstruction of extremities, Gothenburg, Sweden.

Methods: Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling.

Results: Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test-retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities.

Conclusion: Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The proportion of participants responding at each of the five levels ('strongly agree' to 'strongly disagree') to questions in the satisfaction survey.
Figure 2
Figure 2
The average of positive, neutral and negative responses for the domains satisfaction, activities and occupation/schooling.
Figure 3
Figure 3
The proportion of participants responding at each of the five levels ('strongly agree' to 'strongly disagree') to the two questions about functional improvement after hand/wrist and elbow extension surgery, respectively.

References

    1. Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology. J Neurotrauma 2004; 21: 1355–1370.
    1. Freund P, Curt A, Friston K, Thompson A. Tracking changes following spinal cord injury: insights from neuroimaging. Neuroscientist 2013; 19: 116–128.
    1. Simpson LA, Eng JJ, Hsieh JT Wolfe, the Spinal Cord Injury Rehabilitation Evidence Research Team DL. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma 2012; 29: 1548–1555.
    1. 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.
    1. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21: 1371–1383.
    1. Lo C, Tran Y, Anderson K, Craig A, Middleton J. Functional priorities in persons with spinal cord injury: using discrete choice experiments to determine preferences. J Neurotrauma 2016; 33: 1958–1968.
    1. Fridén J, Gohritz A. Tetraplegia management update. J Hand Surg 2015; 40: 2489–2500.
    1. Fridén J, Reinholdt C, Wangdell J, Gohritz A. Upper extremity reconstruction in non-traumatic spinal cord injuries: an under-recognized opportunity. J Rehabil Med 2014; 46: 33–38.
    1. Wangdell J, Carlsson G, Fridén J. From regained function to daily use: experiences of surgical reconstruction of grip in people with tetraplegia. Disabil Rehabil 2014; 36: 678–684.
    1. Wangdell J, Carlsson G, Fridén J. Enhanced independence: experiences after regaining grip function in people with tetraplegia. Disabil Rehabil 2013; 35: 1968–1974.
    1. Wangdell J, Fridén J. Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia. J Hand Surg 2010; 35: 563–568.
    1. Sinnott A, Brander P, Siegert R, Rothwell A, De Jong G. Life impacts following reconstructive hand surgery for tetraplegia. Top Spinal Cord Inj Rehabil 2009; 15: 90–97.
    1. Fridén J, Reinholdt C, Turcsanyii I, Gohritz A. A single-stage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: the alphabet procedure. Tech Hand Up Extrem Surg 2011; 15: 230–235.
    1. Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann 1983; 6: 185–210.
    1. Janse A, Gemke R, Uiterwaal C, Van Der Tweel I, Kimpen J, Sinnema G. Quality of life: patients and doctors don't always agree: a meta-analysis. J Clin Epidemiol 2004; 57: 653–661.
    1. Donabedian A. The quality of care: how can it be assessed? JAMA 1988; 260: 1743–1748.
    1. Wuolle KS, Bryden AM, Peckham PH, Murray PK, Keith M. Satisfaction with upper-extremity surgery in individuals with tetraplegia 1, 2. Arch Phys Med Rehabil 2003; 84: 1145–1149.
    1. 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.
    1. Gregersen H, Lybaek M, Lauge Johannesen I, Leicht P, Nissen UV, Biering-Sorensen F. Satisfaction with upper extremity surgery in individuals with tetraplegia. J Spinal Cord Med 2015; 38: 161–169.
    1. Plant JA, Voulvoulis N, Ragnarsdottir KV Introduction. In Plant JA, Voulvoulis N & Ragnarsdottir KV (eds). Pollutants, Human Health and the Environment: A Risk Based Approach. John Wiley & Sons, Ltd: Chichester, UK 2011.
    1. Bland JM, Altman DG. Statistics notes: Cronbach's alpha. BMJ 1997; 314: 572.
    1. George D, Mallery M. SPSS for Windows step by step: A simple guide and reference 11.0 update, 4th edn. Allyn & Bacon: Boston, MA, USA,. 2003.
    1. McDowell CL, Moberg E, Smith AG. International conference on surgical rehabilitation of the upper limb in tetraplegia. J Hand Surg Am 1979; 4: 387–390.
    1. Embretson SE, Hershberger SL In: The new rules of measurement: What every psychologist and educator should know. Mahwah NJ (eds). Lawrence Erlbaum Associates, Inc., 1999.
    1. van Zyl N, Hahn JB, Cooper CA, Weymouth MD, Flood SJ, Galea MP. Upper limb reinnervation in C6 tetraplegia using a triple nerve transfer: case report. J Hand Surg 2014; 39: 1779–1783.
    1. Dunn J, Hay-Smith E, Whitehead L, Keeling S. Issues influencing the decision to have upper limb surgery for people with tetraplegia. Spinal Cord 2012; 50: 844–847.
    1. Dunn JA, Hay-Smith EJ, Keeling S, Sinnott KA. Decision-making about upper limb tendon transfer surgery by people with tetraplegia for more than 10 years. Arch Phys Med Rehabil 2016; 97: S88–S96.
    1. Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997; 50: 1129–1136.
    1. Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg 2005; 30: 94–99.

Source: PubMed

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