C. A. Harris1, M. J. Shauver1, K. C. Chung1 1University Of Michigan,Plastic Surgery, Department Of Surgery,Ann Arbor, MI, USA
Introduction: Tendon Transfer Surgery can effectively improve hand function for patients with tetraplegia, but remains poorly utilized. Although provider behavior and inconsistent care delivery contribute to low operative rates, there is growing recognition that patients' social and emotional contexts also impact uptake. In particular, evidence suggests that the balance of patients' positive and negative coping behavior can influence their progression to surgery. Yet, how these coping behaviors evolve is not completely understood. This study seeks to probe how patients' early recovery experiences shape their attitudes toward function and identity to impact coping, and ultimately how this shapes their reconstructive context.
Methods: We performed a cross-sectional qualitative analysis of nineteen participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction, 10 had not. Semi-structured interviews were conducted using a standardized interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory methodology and constant comparative analysis.
Results: The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association Grades A-D were represented. Patients' attitudes toward function were largely shaped by the degree to which they recognized rehabilitation’s necessity, experienced functional gains, and built constructive relationships with their therapists. Poor insurance coverage and financial constraints limited rehabilitation access, and decreased patients' hope for improvement. Function impacted identity through the degree to which it tied participants to a ‘patient’ role. We conceptualized this relationship as two spectra: high vs. low function and strong vs. weak patient identity (Figure 1). Early in recovery (e.g. The Golden Year) patients’ function, roles, and attitudes were fluid, but they solidified over time. How satisfied patients were with these final positions influenced how well they coped.
Conclusion: This study adds to our understanding of how patients with tetraplegia build their operative contexts. Depicting function and identity as two related axes demonstrates how these domains continually influence each other, while patients' satisfaction with their places on these spectra becomes the starting point for their coping. Our finding that patients eventually established norm based on their solidified function/identity positions suggests that introducing reconstruction during the Golden Year may help prolong patient's receptiveness to surgery.
