Supporting Patient Decisions About Upper-Extremity Surgery in Cervical Spinal Cord Injury
Abstract
Objective and Rationale: Cervical spinal cord injury (SCI) is a devastating and life-altering injury. Some people with cervical SCI have limited hand function, which reduces their ability to attain independence. For these people, improving upper extremity function is understandably more important to daily living than restoring other functions such as walking. While surgery, including the novel use of transfer techniques, can improve function, the best outcomes rely on early recognition requiring intervention within a year after SCI. Understanding the pros and cons of any surgical intervention, especially in the setting of complex and often incomplete information, is challenging. The goal of this project is to (1) precisely define the time course of natural recovery of upper extremity function after SCI and examine how a statistical model predicts who would or would not benefit from a nerve transfer procedure, (2) describe the experiences of people with SCI and their caregivers with surgical and non-surgical treatments to improve upper extremity function, and (3) make and test a decision support intervention (DSI) that guides users through the facts and allows them to make better informed, statistically valid choices that fit with their own goals and preferences. Ultimate Applicability of This Research: This will be useful to clinicians providing advice to people living with cervical SCI about means to improve upper extremity function. It will also provide a scalable framework that could be used to provide information to people with SCI who are presented with a variety of treatment options for improved function and health. Who It Will Help and How: This project will create a DSI that can be used to help clinicians and people living with cervical level SCI and their caregivers. It will be most useful to those with acute or sub-acute injury (< 1 year after SCI) for both military personnel and the general public. Clinicians and patients will have evidence to help them make decisions about treatments to improve upper extremity function. Clinical Applications, Benefits, and Risks: The completed DSI will be pilot tested and immediately applicable for clinical use. The DSI itself will have immediate potential benefit when disseminated to the appropriate populations, as it will provide information not otherwise readily available about potential treatment options. The main risk of the DSI is that it will create expectations for some procedures (nerve and/or tendon transfer) that may or may not be readily available in the healthcare setting where the user resides. In addition, a complete clinical evaluation (which may include minimally invasive electrodiagnostic testing) is required to determine individual candidacy for a specific surgical procedure. Projected Time to Achieve a Person-Related Outcome: This clinically applicable project will take 3 years? time to construct the deliverable: DSI. Likely Contributions to Advancing SCI Research, Patient Care, Quality of Life: This work addresses and examines surgical interventions in SCI care to improve functional arm and hand recovery, while providing an assessment tool (DSI) to make better informed decisions about surgical treatments and their outcomes. With the plethora of choices and limited available information, our proposal to develop a framework (DSI) to better match treatments to different specific patient needs is appropriate and timely. We will impact the approach to educating clinicians, patients, and caregivers about their options, while outlining the appropriate timing for achieving success with each treatment intervention. This framework will be sustainable, as it can be updated as new treatment strategies evolve and outcome benefits are evaluated. In such a manner, people living with SCI will be empowered to make more well-informed choices consistent with their values, needs, and goals and for maximal benefit to their functioning.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Aug 07, 2017
- Source ID
- W81XWH1710285
Entities
People
- Ida Fox
Organizations
- United States Army
- Washington University in St. Louis