Original Article
Spinal Cord (2008) 46, 228–233; doi:10.1038/sj.sc.3102110; published online 7 August 2007
Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics
G J Snoek1,2, J A van Til2, P F M Krabbe3 and M J IJzerman2,4
- 1Spinal Cord Injury Department, Roessingh Rehabilitation Centre, Enschede, The Netherlands
- 2Research and Development Department, Roessingh Rehabilitation Centre, Enschede, The Netherlands
- 3Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 4Metrohealth Medical Centre, Cleveland, Ohio, USA
Correspondence: Dr GJ Snoek, Spinal Cord Unit, Roessingh Research and Development, Roessinghsbleekweg 33 b, PO Box 310, 7500 AH Enschede, The Netherlands. E-mail: g.snoek@rrd.nl
Received 25 January 2007; Revised 14 June 2007; Accepted 20 June 2007; Published online 7 August 2007.
Abstract
Study Design:
Survey.
Objective:
To determine the effect of treatment characteristics on the decision for reconstructive interventions for the upper extremities (UE) in subjects with tetraplegia.
Setting:
Seven specialized spinal cord injury centres in the Netherlands.
Method:
Treatment characteristics for UE reconstructive interventions were determined. Conjoint analysis (CA) was used to determine the contribution and the relative importance of the treatment characteristics on the decision for therapy. Therefore, a number of different treatment scenarios using these characteristics were established. Different pairs of scenarios were presented to subjects who were asked to choose the preferred scenario of each set.
Results:
Forty-nine subjects with tetraplegia with a stable C5, C6 or C7 lesion were selected. All treatment characteristics significantly influenced the choice for treatment. Relative importance of treatment characteristics were intervention type (surgery or surgery with functional electrical stimulation implant) 13%, number of operations 15%, in-patient rehabilitation period 22%, ambulant rehabilitation period 9%, complication rate 15%, improvement of elbow function 10%, improvement of hand function 15%. In deciding for therapy, 40% of the subjects focused on one characteristic.
Conclusion:
CA is applicable in Spinal Cord Injury medicine to study the effect of health outcomes and non-health outcomes on the decision for treatment. Non-health outcomes, which relate to the intensity of treatment, are equally important or even more important than functional outcome in the decision for reconstructive UE surgery in subjects with tetraplegia.
Keywords:
tetraplegia, hand function, decision-making, reconstructive hand surgery, conjoint analysis
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