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Gouveia D, Cardoso A, Carvalho C, Rijo I, Almeida A, Gamboa Ó, Lopes B, Sousa P, Coelho A, Balça MM, Salgado AJ, Alvites R, Varejão ASP, Maurício AC, Ferreira A, Martins Â. The Role of Early Rehabilitation and Functional Electrical Stimulation in Rehabilitation for Cats with Partial Traumatic Brachial Plexus Injury: A Pilot Study on Domestic Cats in Portugal. Animals (Basel) 2024; 14:323. [PMID: 38275783 PMCID: PMC10812540 DOI: 10.3390/ani14020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
This prospective observational cohort pilot study included 22 cats diagnosed with partial traumatic brachial plexus injury (PTBPI), aiming to explore responses to an early intensive neurorehabilitation protocol in a clinical setting. This protocol included functional electrical stimulation (FES), locomotor treadmill training and kinesiotherapy exercises, starting at the time with highest probability of nerve repair. The synergetic benefits of this multimodal approach were based on the potential structural and protective role of proteins and the release of neurotrophic factors. Furthermore, FES was parametrized according to the presence or absence of deep pain. Following treatment, 72.6% of the cats achieved ambulation: 9 cats within 15 days, 2 cats within 30 days and 5 cats within 60 days. During the four-year follow-up, there was evidence of improvement in both muscle mass and muscle weakness, in addition to the disappearance of neuropathic pain. Notably, after the 60 days of neurorehabilitation, 3 cats showed improved ambulation after arthrodesis of the carpus. Thus, early rehabilitation, with FES applied in the first weeks after injury and accurate parametrization according to the presence or absence of deep pain, may help in functional recovery and ambulation, reducing the probability of amputation.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (I.R.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (I.R.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (I.R.); (Â.M.)
| | - Inês Rijo
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (I.R.); (Â.M.)
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (A.A.); (Ó.G.); (A.F.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (A.A.); (Ó.G.); (A.F.)
| | - Bruna Lopes
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
| | - Patrícia Sousa
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
| | - André Coelho
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
| | - Maria Manuel Balça
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
| | - António J. Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Rui Alvites
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
- Instituto Universitário de Ciências da Saúde (CESPU), Avenida Central de Gandra 1317, 4585-116 Gandra, Portugal
| | - Artur Severo P. Varejão
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
- Department of Veterinary Sciences, Universidade de Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal
- Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5001-801 Vila Real, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; (B.L.); (P.S.); (A.C.); (M.M.B.); (R.A.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (A.A.); (Ó.G.); (A.F.)
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (I.R.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal;
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de Joode SGCJ, Schotanus MGM, Germawi L, Westenberg RF, van Rhijn LW, Chen N, Samijo SK. Transhumeral amputation in brachial plexus lesion patients: A multicenter case series. Orthop Traumatol Surg Res 2023; 109:103360. [PMID: 35792322 DOI: 10.1016/j.otsr.2022.103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/07/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND A flail limb can be the result of a traumatic complete brachial plexus lesion. Some patients prefer retaining the flail limb, however some patients feel that a flail limb negatively affects daily life. In these circumstances an elective amputation is sometimes elected, however long-term follow-up, with respect to satisfaction and function is unknown. The aim of this study is to evaluate the long-term outcome of this rare and life changing operation. MATERIALS AND METHODS 8 patients with a transhumeral amputation performed in 2 specialized medical centers were included. Postoperatively, the functional- and psychological outcome and the quality of life were evaluated with standardized patient reported outcome measures (PROMs; DASH, SIP-68, EQ-5D-5L and HADS). RESULTS After a median of 9.4 (range 7.5 - 12.8) years follow-up, 7 patients (88%) stated that they would undergo the operation again and were satisfied with the results. At latest follow-up the median DASH score was 37.3 (range 8.3-61.7), the median SIP-68 score was 6.5 (range 0-43) and the median HADS score was 3.0 (range 0-14) for anxiety and 3.0 (range 1-19) for depression. In the EQ-5D-5L patients had most difficulties in self-care, usual activities and pain/discomfort. The median overall health status was 69 (range 20-95). DISCUSSION With the right indication a transhumeral amputation is a reasonable option for traumatic complete brachial plexus lesion with satisfying long-term results. LEVEL OF EVIDENCE IV, multicenter case series.
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Affiliation(s)
- Stijn G C J de Joode
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, Netherlands; Department of Orthopaedic Surgery, Balgrist University Hospital, Zürich, Switzerland; School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, Netherlands; School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands; Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lazin Germawi
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, United States
| | - Ritsaart F Westenberg
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, United States
| | - Lodewijk W van Rhijn
- School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands; Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Neal Chen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, United States
| | - Steven K Samijo
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, Netherlands.
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Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am 2023:S0363-5023(23)00302-7. [PMID: 37498270 PMCID: PMC10818022 DOI: 10.1016/j.jhsa.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Psychosocial factors influence pain and recovery after extremity trauma and may be targets for early intervention. This may be of particular interest for patients with adult traumatic brachial plexus injury (BPI), given the broad and devastating impact of the injury. We hypothesized that there would be an association between depressive symptoms, anxiety, and pain interference with preoperative disability and expectations for improvement after BPI surgery. METHODS We enrolled 34 patients into a prospective multicenter cohort study for those undergoing surgery for adult traumatic BPI. Before surgery, participants completed Patient-Reported Outcome Measurement Information System scales for pain interference, anxiety, and depressive symptoms, and a validated BPI-specific measure of disability and expected improvement. We performed Pearson correlation analysis between pain interference, anxiety symptoms, and depressive symptoms with (A) disability and (B) expected improvement. We created separate linear regression models for (A) disability and (B) expected improvement including adjustment for severity of plexus injury, age, sex, and race. RESULTS Among 34 patients, there was a moderate, statistically significant, correlation between preoperative depressive symptoms and higher disability. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. There was no association between severity of plexus injury and disability. Depressive symptoms also were moderately, but significantly, correlated with higher expected improvement. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. CONCLUSIONS Depressive symptoms are associated with greater disability and higher expected improvement before BPI surgery. Screening for depressive symptoms can help BPI teams identify patients who would benefit from early referral to mental health specialists and tailor appropriate expectations counseling for functional recovery. We did not find an association between severity of BPI and patient-reported disability, suggesting either that the scale may lack validity or that the sample is biased. LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mihir J Desai
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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4
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Córdoba-Mosqueda ME, Rasulić L, Savić A, Grujić J, Vitošević F, Lepić M, Mićić A, Radojević S, Mandić-Rajčević S, Jovanović I, Rodríguez-Aceves CA. Quality of life and satisfaction in patients surgically treated for cubital tunnel syndrome. Neurol Res 2023; 45:138-151. [PMID: 36130919 DOI: 10.1080/01616412.2022.2126163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. METHODS This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop's score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). RESULTS Sixty-two patients met the inclusion criteria. Bishop's score: The median score was 10 (7.75-11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6-38.5); for functional, was 14 (0.75-38); and the total was 18.25 (5.87-34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. CONCLUSION Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery.
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Affiliation(s)
- María Elena Córdoba-Mosqueda
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Filip Vitošević
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Aleksa Mićić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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Hill JR, Lanier ST, Rolf L, James AS, Brogan DM, Dy CJ. Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus. Hand (N Y) 2023; 18:14S-21S. [PMID: 34018448 PMCID: PMC9896279 DOI: 10.1177/15589447211014613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons' rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. METHODS We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. RESULTS Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. CONCLUSIONS Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.
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Affiliation(s)
- J. Ryan Hill
- Washington University School of
Medicine, St. Louis, MO, USA
| | | | - Liz Rolf
- Washington University School of
Medicine, St. Louis, MO, USA
| | - Aimee S. James
- Washington University School of
Medicine, St. Louis, MO, USA
| | - David M. Brogan
- Washington University School of
Medicine, St. Louis, MO, USA
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6
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Miller C, Jerosch-Herold C, Cross J. Brachial plexus injury: living with uncertainty. Disabil Rehabil 2022:1-7. [PMID: 35722825 DOI: 10.1080/09638288.2022.2080287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE A traumatic brachial plexus injury (BPI) has life-changing consequences for patients and their families. Despite advancements in treatments final outcome is unpredictable depending on factors including time to treatment, injury severity, neural regeneration, and available interventions. The final outcome may not be seen for up to four years. This study aimed to explore the impact of uncertainty on people with a traumatic BPI. METHODS Secondary qualitative analysis was conducted on data from a study exploring outcomes important to patients with a traumatic BPI. Data from semi-structured interviews with adult traumatic BPI patients (n = 13) were analyzed using reflexive thematic analysis. RESULTS Three major themes were identified in the qualitative data: (i) "I don't know what happened to me," focused on uncertainty in diagnosis. (ii) "I went to work one day… and then it all changed" centered around uncertainty in the future. (iii) Coping with uncertainty. CONCLUSION The results illustrate that people with a traumatic BPI face uncertainty regarding diagnosis, prognosis, and surrounding their roles in the future. Individuals respond to uncertainty in different ways and this needs to be understood by health care professionals. IMPLICATIONS FOR REHABILITATIONHealth professionals should consider uncertainty in all their contacts with people who have experienced a traumatic brachial plexus injury.People with a traumatic brachial plexus injury experience uncertainty in different ways therefore education and information given may be optimized if tailored to the individual rather than generic.Increasing awareness of the injury and its presentation in non-specialist acute care clinicians may accelerate diagnosis and reduce initial uncertainty.Acknowledging the presence of uncertainty is important during the shared decision-making in brachial plexus injuries.
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Affiliation(s)
- Caroline Miller
- School of Health Sciences, University of East Anglia, Norwich, UK.,Therapy Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | | | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich, UK
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7
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Verma CV, Vora T, Thatte M, Yardi S. Patient Perception after Traumatic Brachial Plexus Injury - A Qualitative Case Report. J Hand Ther 2021; 33:593-597. [PMID: 30975622 DOI: 10.1016/j.jht.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/20/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a qualitative case study. INTRODUCTION Considering individual patient's perception is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002). PURPOSE OF STUDY The report highlights the importance of patient education and considering individual's perception to achieve rehabilitation outcomes. METHOD A written informed consent for case report was given by a 24-year-old male, a mass media graduate student diagnosed with global brachial plexus injury. Detailed evaluation by a senior therapist was conducted in a tertiary government hospital using the following tools: RESULT: Patient education and rehabilitation led to signs of clinical improvement at the end of 5 months. In spite of this clinical signs of recovery, patient showed lack of satisfaction in terms of his appearance and body image. DISCUSSION As employment and social life determined our patient's satisfaction level, a negative impact was seen on functional recovery. CONCLUSION Considering an individual's perception regarding the condition in terms of their contextual and personal factors is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002).
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Affiliation(s)
- Chhaya V Verma
- Department of Physiotherapy, Physiotherapy School & Centre, T.N.M.C & B.Y.L.Nair Charitable Hospital, Mumbai, India.
| | - Tanvee Vora
- Department of Physiotherapy, M.P.Th in Musculoskeletal Sciences, Physiotherapy School and Centre, T.N.M.C & B.Y.L.Nair Charitable Hospital, Mumbai, India
| | - Mukund Thatte
- Department of Plastic Surgery, Hand and Microsurgery, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Sujata Yardi
- Department of Physiotherapy, School of Physiotherapy D.Y.Patil University, Navi Mumbai, India
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8
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Cole T, Nicks R, Ferris S, Paul E, O'Brien L, Pritchard E. Outcomes after occupational therapy intervention for traumatic brachial plexus injury: A prospective longitudinal cohort study. J Hand Ther 2021; 33:528-539. [PMID: 32156574 DOI: 10.1016/j.jht.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/23/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective longitudinal cohort study. INTRODUCTION Traumatic brachial plexus injuries (BPIs) can be devastating and negatively impact daily function and quality of life. Occupational therapists play an important role in rehabilitation; however, studies identifying outcomes are lacking. PURPOSE This study aims to describe outcomes including motor recovery, upper limb function, participation, pain, and quality of life for people receiving occupational therapy intervention. METHODS A convenience sample of English-speaking adults (n = 30) with a traumatic BPI, attending the clinic between December 1, 2014, to November 30, 2016, participated. Participants received occupational therapy focusing on sensorimotor retraining and activity-based rehabilitation. Data on active range of motion (goniometry), strength (Medical Research Council (MRC)), upper-limb function (UEFI15, QuickDASH), participation (PSFS), pain (Brief Pain Inventory), and quality of life (EQ-5D-3L) were collected at baseline, 3, 6, 9, and 12 months. RESULTS Elbow flexion strength showed significant improvement at all time-points, average increase 2.17 (MRC) (95% confidence interval: 1.29-3.04; P < .001) and mean final MRC grading 3.86 (standard error: 0.44). Significant improvements at 12 months were seen in: shoulder abduction strength and range, flexion strength and range, external rotation range; elbow extension strength and flexion range; thumb flexion and extension strength. Upper limb function (QuickDASH) showed significant improvement (mean change = 18.85; 95% confidence interval: 4.12-33.59; P = .02). Forearm protonation range and finger flexion strength were significantly worse. Remaining outcomes did not show significant improvement. CONCLUSIONS Occupational therapy with surgical intervention can improve strength, range, and upper limb function with people following traumatic BPI. Further investigations into impact on participation, pain, and quality of life are required.
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Affiliation(s)
- Tanya Cole
- Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia.
| | - Rebecca Nicks
- Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia; Occupational Therapy, Eastern Health, Melbourne, Victoria, Australia
| | - Scott Ferris
- Plastic, Hand and Faciomaxillary Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa O'Brien
- Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
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Gushikem A, Cardoso MDM, Cabral ALL, Barros CSM, Isidro HBTM, Silva JR, Kauer JB, Soares RT. Predictive factors for return to work or study and satisfaction in traumatic brachial plexus injury individuals undergoing rehabilitation: A retrospective follow-up study of 101 cases. J Hand Ther 2021; 36:103-109. [PMID: 34392998 DOI: 10.1016/j.jht.2021.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/19/2021] [Accepted: 06/23/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND An important focus of rehabilitation is thereturn to the meningful occupations which may include work and school activities. PURPOSE The aim of this study is to investigate predictive factors for return to work/study in traumatic brachial plexus injury patients undergoing rehabilitation and to investigate the level of satisfaction with treatment. STUDY DESIGN Retrospective observational study with at least 1 year of follow-up. METHODS One hundred and one individuals with traumatic brachial plexus injury enrolled in this study. Primary outcomes were return to work/study and satisfaction with treatment. A secondary outcome was the self-perception of what influenced return to work. Sociodemographic and related to injury data, rehabilitation interventions, muscle strength, and disability were analyzed as predictors. Associations were investigated using univariable and discriminant analysis and considered a level of significance of P < .05. RESULTS Return to work/study occurred in 55% of the patients who participated in this study. Muscle strength discerned those who returned to work. Time interval between trauma and surgery and age were lower in those who returned to work. Thirty-one patients answered the question regarding self-perception of what influenced return to work. They indicated "necessity", "rehabilitation", "my desire" and "not become depressed". Satisfaction was graded between 8.9 and 9.5 in 95% of the cases. CONCLUSIONS Return to work/study was related to muscle strength improvement and those who returned were younger and had less time elapsed from trauma. Individual factors and rehabilitation were pointed out as helpful in aiding return to work. Satisfaction with treatment was high. These findings can help to optimize goals in the rehabilitation environment.
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Affiliation(s)
- Andreia Gushikem
- Physiotherapy department, SARAH Rehabilitation Hospital Network, Brasilia, Brazil.
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10
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Li X, Qiao XF, Sun L, Wang GP, Bai YH. Application of situational adaptation training combined with childlike nursing for children undergoing tonsillectomy or adenoidectomy. Int J Pediatr Otorhinolaryngol 2021; 145:110707. [PMID: 33887548 DOI: 10.1016/j.ijporl.2021.110707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/22/2021] [Accepted: 04/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to investigate the clinical effect of situational adaptation training combined with child-friendly nursing in relieving the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy. METHODS A total of 160 children undergoing tonsillectomy or adenoidectomy were randomly divided into two groups: a control group and a test group. In addition to the routine operating room nursing in the control group, children in the test group underwent situational adaptation training one day before surgery and child-friendly nursing on the day of surgery. The heart rates and differences in average dynamic pressure were compared between groups, both preoperatively and during anesthesia induction. The cooperativeness with anesthesia was also assessed. The anxiety states of children and their family members after the interventions were scored using the anxiety visual analog scale (VAS). The postoperative satisfaction with nursing was assessed and compared between groups. RESULTS The heart rates, differences in average dynamic pressure, cooperativeness with anesthesia, and VAS scores were significantly lower in the test group than in the control group. The VAS scores of family members were significantly lower in the test group than in the control group. The satisfaction degrees with nursing were significantly higher in the test group than in the control group. CONCLUSION Situational adaptation training combined with child-friendly nursing can significantly relieve the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy and their family members. This treatment improves child cooperativeness during therapy, significantly reduces the amplitude of physiological stress response during surgery, and increases the satisfaction with nursing. Thus, situational adaptation training combined with child-friendly nursing is worthy of application in clinics.
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Affiliation(s)
- Xin Li
- Department of Surgery, Children's Hospital of Shanxi Province, Taiyuan, 030001, China
| | - Xiao-Feng Qiao
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, 030001, China.
| | - Lu Sun
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, 030001, China
| | - Guo-Ping Wang
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, 030001, China
| | - Yin-Huan Bai
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, 030001, China
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11
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Sturma A, Hruby LA, Boesendorfer A, Pittermann A, Salminger S, Gstoettner C, Politikou O, Vujaklija I, Farina D, Aszmann OC. Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury. Front Neurorobot 2021; 15:645261. [PMID: 33994986 PMCID: PMC8119996 DOI: 10.3389/fnbot.2021.645261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/01/2021] [Indexed: 01/10/2023] Open
Abstract
Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5–5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.
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Affiliation(s)
- Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Neurorehabilitation Engineering Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Pittermann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Clinical Psychology, General Hospital of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Vujaklija
- Bionic and Rehabilitation Engineering Research Group, Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Dario Farina
- Neurorehabilitation Engineering Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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12
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Diagnostic Accuracy of the Magnetic Resonance Imaging in Adult Post-Ganglionic Brachial Plexus Traumatic Injuries: A Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11020173. [PMID: 33573175 PMCID: PMC7911314 DOI: 10.3390/brainsci11020173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Traumatic brachial plexus injuries are rare but serious consequences of major traumas. Pre-ganglionic lesions are considered irreparable, while post-ganglionic injuries can be potentially treated if an early diagnosis is available. Pre-surgical diagnosis is important to distinguish low-grade from high-grade lesions and to identify their location. The aim of the review is to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the identification of adult post-ganglionic lesions due to traumatic brachial plexus injuries, compared to intraoperative findings. Methods: Research on the main scientific electronic databases was conducted. Studies of adults with traumatic post-ganglionic brachial plexus injuries were included. The index test was preoperative MRI and the reference standard was surgical exploration. Pooled sensitivity and specificity were calculated. Results: Four studies were included for the systematic review, of which three articles met the inclusion criteria for the meta-analysis. Pooled sensitivity and pooled specificity values resulted high. The sensitivity value is associated with a high heterogeneity index of the selected literature. Conclusion: MRI can be considered, despite the limits, the gold standard exam in morphological evaluation of brachial plexus injuries, particularly in the diagnosis of post-ganglionic traumatic injuries.
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13
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Dy CJ, Brogan DM, Rolf L, Ray WZ, Wolfe SW, James AS. A qualitative study of life satisfaction after surgery for adult traumatic brachial plexus injury. Bone Jt Open 2021; 2:9-15. [PMID: 33537671 PMCID: PMC7842160 DOI: 10.1302/2633-1462.21.bjo-2020-0175.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aims Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care. Methods We conducted semi-structured interviews with 15 BPI patients after initial nerve reconstruction. The interview guide was focused on the patient’s experience after BPI, beginning with the injury itself and extending beyond surgical reconstruction. Inductive and deductive thematic analysis was used according to standard qualitative methodology to better understand overall life satisfaction after BPI, contributors to life satisfaction, and opportunities for improvement. Results Among the 15 patients interviewed, the following themes emerged: 1) happiness and life satisfaction were noted despite limitations in physical function; 2) quality of social support influences life satisfaction during recovery from BPI; and 3) social participation and having a sense of purpose impact life satisfaction during recovery from BPI. Conclusion How patients perceive their BPI treatment and recovery varies widely, and is not directly linked to their self-reported functional outcome. Patients with stronger social circles and activities that give them a sense of fulfillment were more likely to be satisfied with their current status. Evaluating a patient’s social network, goals, and potential supportive adaptations early in the treatment timeline through coordinated multidisciplinary care may improve overall satisfaction during recovery from BPI. Cite this article: Bone Joint Open 2020;2(1):9–15.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Liz Rolf
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Sachar R, Landau AJ, Ray WZ, Brogan DM, Dy CJ. Social Support and Coping Strategies in Patients with Traumatic Brachial Plexus Injury. HSS J 2020; 16:468-474. [PMID: 33380981 PMCID: PMC7749904 DOI: 10.1007/s11420-020-09814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emotional and social characteristics may influence rehabilitation and recovery after traumatic brachial plexus injury. PURPOSES We sought to investigate if traumatic brachial plexus injury patients have different levels of social support and employ distinct coping strategies from uninjured control subjects. In addition, we studied which coping strategies are more commonly used among traumatic brachial plexus injury patients. METHODS Questionnaires for social support (Interpersonal Support Evaluation List and Social Support Questionnaire) and coping strategies (Brief-Coping Orientation to Problems Experienced) were administered to traumatic brachial plexus injury patients and an age- and sex-matched volunteer cohort (without brachial plexus injury). RESULTS There were no differences in interpersonal support (mean [SD] = 26.0 [8.6], 26.5 [6.8]), number of persons available for emotional support, and satisfaction with support between traumatic brachial plexus injury patients (n = 36) and volunteers (n = 43). The following coping strategies were more common among traumatic brachial plexus injury patients: active coping, self-distraction, denial, behavioral disengagement, venting, planning, self-blame, and acceptance. CONCLUSION Patients with traumatic brachial plexus injury have similar levels of social support as healthy volunteers but are more likely to use an array of coping strategies. Surgeons and other clinicians should be aware of coping strategies favored by patients, particularly the potential for behaviors detrimental to recovery such as behavioral disengagement, self-blame, and denial. This work will inform future investigations into the influence of social support and coping strategies on clinical outcomes after traumatic brachial plexus injury.
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Affiliation(s)
- Ryan Sachar
- Department of Orthopaedic Surgery, Division of Hand and Microsurgery, Washington University School of Medicine, 4291 Parkview Place, St. Louis, MO USA
| | - Andrew J. Landau
- Department of Orthopaedic Surgery, Division of Hand and Microsurgery, Washington University School of Medicine, 4291 Parkview Place, St. Louis, MO USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St. Louis, MO USA
| | - David M. Brogan
- Department of Orthopaedic Surgery, Division of Hand and Microsurgery, Washington University School of Medicine, 4291 Parkview Place, St. Louis, MO USA
| | - Christopher J. Dy
- Department of Orthopaedic Surgery, Division of Hand and Microsurgery, Washington University School of Medicine, 4291 Parkview Place, St. Louis, MO USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO USA
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15
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Dy CJ, Brogan DM, Rolf L, Ray WZ, Wolfe SW, James AS. Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 3:30-35. [PMID: 33537663 PMCID: PMC7853659 DOI: 10.1016/j.jhsg.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons’ perspectives on the care of BPI patients and potential areas for improvement in care delivery. Methods We conducted semistructured qualitative interviews with 14 surgeons with expertise in BPI reconstruction. The interview guide contained questions regarding the surgeons’ practice and care team structure, their attitudes and approaches to psychological and emotional aspects of recovery, and their preferences for setting patient expectations. We used inductive thematic analysis to identify themes. Results There was a high degree of variability in how surgeons addressed emotional and psychological aspects of recovery. Whereas some surgeons embraced the practice of addressing these components of care, others felt strongly that BPI surgeons should remain focused on technical aspects of care. Several participants described the emotional toll that caring for BPI patients can have on surgeons and how this concern has affected their approach to care. Surgeons also recognized the importance of setting preoperative expectations. There was an emphasis on setting low expectations in an attempt to minimize the risk for dissatisfaction. Surgeons described the challenges in effectively counseling patients about a condition that is prone to substantial injury heterogeneity and variability in functional outcomes. Conclusions Our results demonstrate wide variability in how surgeons address emotional, psychological, and social barriers to recovery for BPI patients. Clinical relevance Best practices for BPI care are difficult to establish because of the relative heterogeneity of neurologic injury, the unpredictable impact and recovery of the patient, and the substantial variability in physician approach to the care of these patients.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Liz Rolf
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
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16
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Smolev ET, Rolf L, Zhu E, Buday SK, Brody M, Brogan DM, Dy CJ. "Pill Pushers and CBD Oil"-A Thematic Analysis of Social Media Interactions About Pain After Traumatic Brachial Plexus Injury. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 3:36-40. [PMID: 33537664 PMCID: PMC7853657 DOI: 10.1016/j.jhsg.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose Brachial plexus injury (BPI) patients use on-line groups for peer support, often seeking information from Facebook groups devoted to BPI. We hypothesized that a qualitative thematic analysis of posts from BPI Facebook groups would demonstrate the areas in which patients were seeking information regarding treatment of BPI and reveal potential sources of misinformation that patients may encounter. Methods We identified the 2 most popular public Facebook groups for BPI by searching key words “traumatic brachial plexus injury.” We selected posts containing comments regarding BPI from November 1, 2018 through October 31, 2019. We excluded posts regarding brachial plexus birth injury. We used iterative inductive and deductive thematic analysis for the qualitative data to identify recurring topics, knowledge gaps, potential roles of patient educational interventions, and patient interaction dynamics. Two investigators independently coded all posts and resolved discrepancies by discussion. Results A total of 7,694 posts from 2 leading Facebook support groups were analyzed. Three themes emerged: (1) When discussing pain management, there was recurring anti-opioid sentiment. Posters who currently used opioids or supported those who did discussed perceived effects of the opioid epidemic on their treatment, on their relationships with care providers, and on availability of the medication. (2) Posters advocated for alternatives to traditional approaches to pain management, referring to prescribers as pill pushers and touting cannabinoids as a safer and more effective replacement. (3) There was strong anti-gabapentinoid sentiment owing to reported adverse effects and a perceived lack of efficacy, despite its role as a first-line treatment for neuropathic pain. Conclusions Examination of posts from Facebook support groups for BPI revealed recurring themes, questions, misinformation, and opinions from posters with regard to treatment of neuropathic pain. These findings can help clinicians who care for BPI patients identify areas to focus on during patient encounters to address neuropathic pain that commonly occurs with BPI. Clinical relevance Brachial plexus injury surgeons should be aware of information, misinformation, and opinions on social media, because these may influence patient–surgeon interactions.
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Affiliation(s)
- Emma T Smolev
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Liz Rolf
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Eric Zhu
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Sarah K Buday
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Madison Brody
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
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17
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Osborn AJ, Roberts RM, Mathias JL, Anderson PJ, Flapper WJ. Cognitive, behavioral and psychological functioning of children and adults with conservatively managed metopic synostosis. Child Neuropsychol 2020; 27:190-208. [PMID: 32900282 DOI: 10.1080/09297049.2020.1817356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Children diagnosed with metopic synostosis (MS) commonly experience poor neuropsychological outcomes, with research suggesting that children whose MS is managed conservatively (without surgery) potentially having worse outcomes than their operated peers. However, studies of children whose MS was managed conservatively are scarce. This study therefore examined the cognitive, behavioral, and psychological functioning of children/adults with conservatively managed MS (N = 38) and compares their outcomes to individually matched healthy controls (N = 38) of the same age and sex (matched-pairs design) from the general community. Age-appropriate, validated assessments measuring general cognition, verbal and visuospatial ability, attention and working memory, executive functioning, behavior, depression, anxiety, and satisfaction with appearance were utilized. Group differences were estimated using linear regression for (a) the overall sample and (b) by broad developmental stages: 2&3 yrs; ≥6-≤17. Moderate to large negative effects (g = -0.38 to -1.30) were evident before controlling for socio-economic status (SES), with the MS group performing significantly worse on 8 out of the 10 cognitive domains (general cognition, visuospatial ability, working memory, information processing, executive functioning: semantic & initial letter verbal fluency, switching, inhibition+switching). However, only initial letter verbal fluency (g = -0.99) and switching (g = -1.19) remained significant after adjusting for SES. The MS group displayed more behavioral problems, although this was not significant. Depression, anxiety, and satisfaction with appearance did not differ between the groups. Regular monitoring of cognitive functioning, particularly executive functioning, should be undertaken for those with conservatively managed MS.
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Affiliation(s)
- A J Osborn
- School of Psychology, University of Adelaide , Adelaide, South Australia, Australia
| | - R M Roberts
- School of Psychology, University of Adelaide , Adelaide, South Australia, Australia
| | - J L Mathias
- School of Psychology, University of Adelaide , Adelaide, South Australia, Australia
| | - P J Anderson
- The Australian Craniofacial Unit, Women's and Children's Hospital , North Adelaide, South Australia, Australia
| | - W J Flapper
- The Australian Craniofacial Unit, Women's and Children's Hospital , North Adelaide, South Australia, Australia
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18
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Clinical, Electrodiagnostic Findings and Quality of Life of Dogs and Cats with Brachial Plexus Injury. Vet Sci 2020; 7:vetsci7030101. [PMID: 32751944 PMCID: PMC7558042 DOI: 10.3390/vetsci7030101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Brachial plexus injury (BPI) represents a common consequence of road traffic accidents in humans and small animals. In humans, neuropathic pain is a common symptom after BPI. The aim of the study was to describe the clinical signs, the electrodiagnostic findings, the outcome and the quality of life (QoL) of a cohort of dogs and cats with BPI. Clinical records of 40 dogs and 26 cats with BPI were retrospectively reviewed. Specific attention was put on the evaluation of electrodiagnostic findings (35/40 dogs; 14/26 cats) and telephonic interview results (26/40 dogs; 18/26 cats). The most common neurological condition was the inability to bear weight and sensory deficits on the affected limb. Radial and ulnar motor nerve conduction studies (MNCSs) were absent respectively in 47% (radial) and 62% (ulnar) of dogs and 57% (radial) and 57% (ulnar) of cats. The absence of radial (p = 0.003) and ulnar (p = 0.007) MNCSs in dogs and ulnar MNCSs in cats (p = 0.02) was significantly associated to the amputation of the affected limb. The owners described signs of pain/discomfort in 73% of dogs and 56% of cats. This is the first report suggesting that neuropathic pain/discomfort should be adequately considered in order to improve the QoL.
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19
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Wade RG, Tanner SF, Teh I, Ridgway JP, Shelley D, Chaka B, Rankine JJ, Andersson G, Wiberg M, Bourke G. Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study. Front Surg 2020; 7:19. [PMID: 32373625 PMCID: PMC7177010 DOI: 10.3389/fsurg.2020.00019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
Cross-sectional MRI has modest diagnostic accuracy for diagnosing traumatic brachial plexus root avulsions. Consequently, patients either undergo major exploratory surgery or months of surveillance to determine if and what nerve reconstruction is needed. This study aimed to develop a diffusion tensor imaging (DTI) protocol at 3 Tesla to visualize normal roots and identify traumatic root avulsions of the brachial plexus. Seven healthy adults and 12 adults with known (operatively explored) unilateral traumatic brachial plexus root avulsions were scanned. DTI was acquired using a single-shot echo-planar imaging sequence at 3 Tesla. The brachial plexus was visualized by deterministic tractography. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated for injured and avulsed roots in the lateral recesses of the vertebral foramen. Compared to healthy nerves roots, the FA of avulsed nerve roots was lower (mean difference 0.1 [95% CI 0.07, 0.13]; p < 0.001) and the MD was greater (mean difference 0.32 × 10-3 mm2/s [95% CI 0.11, 0.53]; p < 0.001). Deterministic tractography reconstructed both normal roots and root avulsions of the brachial plexus; the negative-predictive value for at least one root avulsion was 100% (95% CI 78, 100). Therefore, DTI might help visualize both normal and injured roots of the brachial plexus aided by tractography. The precision of this technique and how it relates to neural microstructure will be further investigated in a prospective diagnostic accuracy study of patients with acute brachial plexus injuries.
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Affiliation(s)
- Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Steven F Tanner
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P Ridgway
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - David Shelley
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Brian Chaka
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - James J Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Gustav Andersson
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom.,Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
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Smith BW, Chang KWC, Saake SJ, Yang LJS, Chung KC, Brown SH. Quantifying Real-World Upper-Limb Activity Via Patient-Initiated Movement After Nerve Reconstruction for Upper Brachial Plexus Injury. Neurosurgery 2020; 85:369-374. [PMID: 30060090 DOI: 10.1093/neuros/nyy335] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/21/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery. OBJECTIVE To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study. METHODS Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. RESULTS The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P = .008) and 0.99 (P = .002), respectively. CONCLUSION Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.
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Affiliation(s)
- Brandon W Smith
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kate W-C Chang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Serena J Saake
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Susan H Brown
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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21
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Brito S, White J, Thomacos N, Hill B. The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study. Disabil Rehabil 2019; 43:1517-1525. [PMID: 31574227 DOI: 10.1080/09638288.2019.1668970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic, pan-brachial plexus injuries result in major functional disability. Surgical advancements, such as free-functioning muscle transfers, are restoring physical capacity that was not achieved 3-4 decades ago. Despite reconstructive procedures, brachial plexus injury patients report chronic pain, changes in work circumstances, concerns about their appearance, increased reliance on others, and difficulty completing daily activities. This suggests that recovery needs to be considered to better deliver post-injury health services. OBJECTIVES Investigate the lived-experience of patients following free-functioning muscle transfers for management of traumatic, pan-brachial plexus injuries.Better understand issues during recovery and implications for rehabilitation with this population. METHODS A phenomenological, qualitative design was employed that involved 5 participants who underwent surgery between 2007 and 2015. In-depth, semi-structured interviews were conducted and data were analyzed using interpretative phenomenological analysis. RESULTS Three interrelated themes were generated from the data. The first theme 'Experience of health care systems' captures the participants' reflections of their post-injury experience and health care received. The second 'Psychosocial considerations' consists of emotional responses, relationship disturbance, and coming to terms with the permanence of their changed arm. The last theme, 'Creating a new self-identity', relates to the participants experience of adjustment to their new circumstances. CONCLUSIONS The findings of this study demonstrate that comprehensive medical coverage and access to expert brachial plexus injury health providers support patients following injury. However, recovery also requires the need for the patient to adjust and establish a new self-concept. Health care providers can assist patients by establishing positive therapeutic relationships, as well as, reducing the number of care providers by providing a continuity of care from the same health professionals.IMPLICATIONS FOR REHABILITATIONIndividuals with pan-brachial plexus injuries felt it was beneficial to work with health care providers with extensive brachial plexus injury knowledge.Stable, long-term relationships with health providers during rehabilitation were reported as beneficial to recovery.Greater consideration of the process of adjustment and creating a new self-identity following pan-brachial plexus injury needs to be considered during rehabilitation.
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Affiliation(s)
- Sara Brito
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Jennifer White
- Department of Physiotherapy, Monash University, Frankston, Australia
| | - Nikos Thomacos
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Bridget Hill
- Epworth Monash Rehabilitation Medicine Unit, Epworth Hospital, Richmond, Australia
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22
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Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, Bourke G. MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology 2019; 293:125-133. [DOI: 10.1148/radiol.2019190218] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Hong TS, Tian A, Sachar R, Ray WZ, Brogan DM, Dy CJ. Indirect Cost of Traumatic Brachial Plexus Injuries in the United States. J Bone Joint Surg Am 2019; 101:e80. [PMID: 31436660 PMCID: PMC7406142 DOI: 10.2106/jbjs.18.00658] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traumatic brachial plexus injuries (BPIs) disproportionately affect young, able-bodied individuals. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI. METHODS We estimated indirect costs as the sum of (1) short-term wage loss, (2) long-term wage loss, and (3) disability payments. Short-term (6-month) wage loss was the product of missed work days and the average earnings per day. The probability of return to work was derived from a systematic review of the literature, and long-term wage loss and disability payments were estimated. Monte Carlo simulation was used to perform a sensitivity analysis of long-term wage loss by varying age, sex, and return to work simultaneously. Disability benefits were estimated from U.S. Social Security Administration data. All cost estimates are in 2018 U.S. dollars. RESULTS A systematic review of the literature demonstrated that the patients with BPI had a mean age of 26.4 years, 90.5% were male, and manual labor was the most represented occupation. On the basis on these demographics, our base case was a 26-year-old American man working as a manual laborer prior to BPI, with an annual wage of $36,590. Monte Carlo simulation estimated a short-term wage loss of $22,740, a long-term wage loss of $737,551, and disability benefits of $353,671. The mean total indirect cost of traumatic BPI in the Monte Carlo simulations was $1,113,962 per patient over the post-injury lifetime (median: $801,723, interquartile range: $22,740 to $2,350,979). If the probability of the patient returning to work at a different, lower-paying job was doubled, the per-patient total indirect cost was $867,987. CONCLUSIONS BPI can have a far-reaching economic impact on both individuals and society. If surgical reconstruction enables patients with a BPI to return to work, the indirect cost of this injury decreases. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas S. Hong
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
| | - Andrea Tian
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
| | - Ryan Sachar
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
| | - Wilson Z. Ray
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
| | - David M. Brogan
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
| | - Christopher J. Dy
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery (T.S.H., A.T., R.S., D.M.B., and C.J.D.), Department of Neurosurgery (W.Z.R.), and Division of Public Health Sciences, Department of Surgery (C.J.D.), Washington University School of Medicine, Saint Louis, Missouri
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24
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Rezzadeh K, Donnelly M, Vieira D, Daar D, Shah A, Hacquebord J. The extent of brachial plexus injury: an important factor in spinal accessory nerve to suprascapular nerve transfer outcomes. Br J Neurosurg 2019; 34:591-594. [DOI: 10.1080/02688697.2019.1639620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Kevin Rezzadeh
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Megan Donnelly
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Dorice Vieira
- Sid and Ruth Lapidus Health Sciences Library, New York University School of Medicine, New York, NY, USA
| | - David Daar
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ajul Shah
- All Florida Orthopedics, Saint Petersburg, FL, USA
| | - Jacques Hacquebord
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA
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25
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Miller C, Cross J, Power DM, Kyte D, Jerosch-Herold C. Development of a core outcome set for traumatic brachial plexus injuries (COMBINE): study protocol. BMJ Open 2019; 9:e030146. [PMID: 31201195 PMCID: PMC6575635 DOI: 10.1136/bmjopen-2019-030146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Traumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care. METHODS AND ANALYSIS This mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS. ETHICS AND DISSEMINATION The use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval. TRIAL REGISTRATION NUMBERS CRD42018109843.
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Affiliation(s)
- Caroline Miller
- School of Health Sciences, University of East Anglia, Norwich, UK
- University Hospitals Birmingham NHS Foundation Trust, Physiotherapy Department, Queen Elizabeth Hospital, Birmingham, UK
| | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Dominic M Power
- The Birmingham Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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26
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The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients. PLoS One 2019; 14:e0214991. [PMID: 30995268 PMCID: PMC6469760 DOI: 10.1371/journal.pone.0214991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system’s impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed.
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27
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Elsayed GA, Menendez JY, Tabibian BE, Chagoya G, Omar NB, Zeiger E, Walters BC, Walker H, Guthrie BL. Patient Satisfaction in Surgery for Parkinson's Disease: A Systematic Review of the Literature. Cureus 2019; 11:e4316. [PMID: 31183296 PMCID: PMC6538104 DOI: 10.7759/cureus.4316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of the study was to establish how patient satisfaction with surgical treatment of Parkinson's disease (PD) has been previously measured, determine whether an ideal patient satisfaction instrument exists, and to define the dimensions of care that determine patient satisfaction with the surgical treatment of PD. A systematic search of four online databases, unpublished sources, and citations was undertaken to identify 15 studies reporting patient satisfaction with the surgical treatment of PD. Manuscripts were reviewed and instruments were categorized by content and method axes. One study was found to utilize two distinct patient satisfaction instruments, which brought the total number of satisfaction instruments assessed to 16. Major factors influencing patient satisfaction were identified and served as a structure to define the dimensions of patient satisfaction in the surgical treatment of PD. Studies used predominantly multidimensional (10/16), rather than global (6/16) satisfaction instruments. Generic (12/16) rather than disease-specific (4/16) instruments were utilized more frequently. Every study reported on satisfaction with outcome and four studies reported on satisfaction with outcome and care. Six dimensions of patient status, outcome and care experience affecting patient satisfaction were identified: motor function, patient-specific health characteristics, programming/long-term care, surgical considerations, device/hardware, and functional independence. At present, no patient satisfaction instrument exists that is disease-specific and covers all dimensions of patient satisfaction in surgery for PD. For quality improvement, such a disease-specific, comprehensive patient satisfaction instrument should be designed, and, if demonstrated to be reliable and valid, widely implemented.
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Affiliation(s)
- Galal A Elsayed
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Joshua Y Menendez
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Borna E Tabibian
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Gustavo Chagoya
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nidal B Omar
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Evan Zeiger
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Beverly C Walters
- Neurological Surgery, University of Alabama at Birmimgham, Birmingham, USA
| | - Harrison Walker
- Neurology, University of Alabama at Birmingham, Birmingham, USA
| | - Barton L Guthrie
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
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28
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Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, Bourke G. Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy. Syst Rev 2018; 7:76. [PMID: 29778092 PMCID: PMC5960500 DOI: 10.1186/s13643-018-0737-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/01/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Adult brachial plexus injuries (BPI) are becoming more common. The reconstruction and prognosis of pre-ganglionic injuries (root avulsions) are different to other types of BPI injury. Preoperative magnetic resonance imaging (MRI) is being used to identify root avulsions, but the evidence from studies of its diagnostic accuracy are conflicting. Therefore, a systematic review is needed to address uncertainty about the accuracy of MRI and to guide future research. METHODS We will conduct a systematic search of electronic databases alongside reference tracking. We will include studies of adults with traumatic BPI which report the accuracy of preoperative MRI (index test) against surgical exploration of the roots of the brachial plexus (reference standard) for detecting either of the two target conditions (any root avulsion or any pseudomeningocoele as a surrogate marker of root avulsion). We will exclude case reports, articles considering bilateral injuries and studies where the number of true positives, false positives, false negatives and true negatives cannot be derived. The methodological quality of the included studies will be assessed using a tailored version of the QUADAS-2 tool. Where possible, a bivariate model will be used for meta-analysis to obtain summary sensitivities and specificities for both target conditions. We will investigate heterogeneity in the performance of MRI according to field strength and the risk of bias if data permits. DISCUSSION This review will summarise the current diagnostic accuracy of MRI for adult BPI, identify shortcomings and gaps in the literature and so help to guide future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049702 .
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Affiliation(s)
- Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK. .,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Justin C R Wormald
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - John P Ridgway
- Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Steven Tanner
- Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - James J Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK.,Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
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29
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Psychometric Evaluation of the Brachial Assessment Tool Part 1: Reproducibility. Arch Phys Med Rehabil 2018; 99:629-634. [DOI: 10.1016/j.apmr.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 08/22/2017] [Accepted: 10/18/2017] [Indexed: 11/20/2022]
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30
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Hill B, Williams G, Olver J, Ferris S, Bialocerkowski A. Preliminary Psychometric Evaluation of the Brachial Assessment Tool Part 2: Construct Validity and Responsiveness. Arch Phys Med Rehabil 2018; 99:736-742. [DOI: 10.1016/j.apmr.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 10/29/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
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31
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Li F, Wang SF, Li PC, Xue YH, Zou JY, Li WJ. Restoration of active pick-up function in patients with total brachial plexus avulsion injuries. J Hand Surg Eur Vol 2018; 43:269-274. [PMID: 28872413 DOI: 10.1177/1753193417728405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We designed multiple nerve transfers in one surgery to restore active pick-up function in patients with total brachial plexus avulsion injuries. Forty patients with total brachial plexus avulsion injuries first underwent multiple nerve transfers. These included transfer of the accessory nerve onto the suprascapular nerve to recover shoulder abduction, contralateral C7 nerve onto the lower trunk via the modified prespinal route with direct coaptation to restore lower trunk function and onto the musculocutaneous nerve with interpositional bridging by medial antebrachial cutaneous nerve arising from lower trunk to restore elbow flexion, and the phrenic nerve onto the posterior division of lower trunk to recover elbow and finger extension. At least three years after surgery, the patients who had a meaningful recovery were selected to perform secondary reconstruction to restore active pick-up function. Active pick-up function was successfully restored in ten patients after they underwent multiple nerve transfers combined with additional secondary functional hand reconstructions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Feng Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Shu-Feng Wang
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Peng-Cheng Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Yun-Hao Xue
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Ji-Yao Zou
- 2 Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Wen-Jun Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
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32
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Mancuso CA, Lee SK, Saltzman EB, Model Z, Landers ZA, Dy CJ, Wolfe SW. Development of a Questionnaire to Measure Impact and Outcomes of Brachial Plexus Injury. J Bone Joint Surg Am 2018; 100:e14. [PMID: 29406348 DOI: 10.2106/jbjs.17.00497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The physical and psychological impact of brachial plexus injury (BPI) has not been comprehensively measured with BPI-specific scales. Our objective was to develop and test a patient-derived questionnaire to measure the impact and outcomes of BPI. METHODS We developed a questionnaire in 3 phases with preoperative and postoperative patients. Phase 1 included interviews of patients using open-ended questions addressing the impact of BPI and improvement expected (preoperative patients) or received (postoperative patients). Phase 2 involved assembling a draft questionnaire and administering the questionnaire twice to establish test-retest reliability. Phase 3 involved selecting final items, developing a scoring system, and assessing validity. Patient scores using the questionnaire were assessed in comparison with scores of the Disabilities of the Arm, Shoulder and Hand (DASH) and RAND-36 measures. RESULTS Patients with partial or complete plexopathy participated. In Phase 1 (23 patients), discrete categories were discerned from open-ended responses and became items for the preoperative and postoperative versions of the questionnaire. In Phase 2 (50 patients [14 from Phase 1]), test-retest reliability was established, with weighted kappa values of ≥0.50 for all items. In Phase 3, 43 items were retained and grouped into 4 subscales: symptoms, limitations, emotion, and improvement expected (preoperative) or improvement received (postoperative). A score for each subscale, ranging from 0 to 100, can be calculated, with higher scores indicating more symptoms, limitations, and emotional distress, and greater improvement expected (or received). Preoperative scores were worse than postoperative scores for the symptoms, limitations, and emotion subscales (composite score of 48 compared with 38; p = 0.05), and more improvement was expected than was received (69 compared with 53; p = 0.01). Correlations with the DASH (0.44 to 0.74) and RAND-36 (0.23 to 0.80) for related scales were consistent and moderate, indicating that the new questionnaire is valid and distinct. CONCLUSIONS We developed a patient-derived questionnaire that measures the physical and psychological impact of BPI on preoperative and postoperative patients and the amount of improvement expected or received from surgery. This BPI-specific questionnaire enhances the comprehensive assessment of this population.
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Affiliation(s)
- Carol A Mancuso
- Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Steve K Lee
- Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | | | - Zina Model
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | - Scott W Wolfe
- Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
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Hruby LA, Pittermann A, Sturma A, Aszmann OC. The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries. PLoS One 2018; 13:e0189592. [PMID: 29298304 PMCID: PMC5751989 DOI: 10.1371/journal.pone.0189592] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/13/2017] [Indexed: 01/01/2023] Open
Abstract
Background Global brachial plexopathies cause major sensory and motor deficits in the affected arm and hand. Many patients report of psychosocial consequences including chronic pain, decreased self-sufficiency, and poor body image. Bionic reconstruction, which includes the amputation and prosthetic replacement of the functionless limb, has been shown to restore hand function in patients where classic reconstructions have failed. Patient selection and psychological evaluation before such a life-changing procedure are crucial for optimal functional outcomes. In this paper we describe a psychosocial assessment procedure for bionic reconstruction in patients with complete brachial plexopathies and present psychosocial outcome variables associated with bionic reconstruction. Methods Between 2013 and 2017 psychosocial assessments were performed in eight patients with global brachial plexopathies. We conducted semi-structured interviews exploring the psychosocial adjustment related to the accident, the overall psychosocial status, as well as motivational aspects related to an anticipated amputation and expectations of functional prosthetic outcome. During the interview patients were asked to respond freely. Their answers were transcribed verbatim by the interviewer and analyzed afterwards on the basis of a pre-defined item scoring system. The interview was augmented by quantitative evaluation of self-reported mental health and social functioning (SF-36 Health Survey), body image (FKB-20) and deafferentation pain (VAS). Additionally, psychosocial outcome variables were presented for seven patients before and after bionic reconstruction. Results Qualitative data revealed several psychological stressors with long-term negative effects on patients with complete brachial plexopathies. 88% of patients felt functionally limited to a great extent due to their disability, and all of them reported constant, debilitating pain in the deafferented hand. After bionic reconstruction the physical component summary scale increased from 30.80 ± 5.31 to 37.37 ± 8.41 (p-value = 0.028), the mental component summary scale improved from 43.19 ± 8.32 to 54.76 ± 6.78 (p-value = 0.018). VAS scores indicative of deafferentation pain improved from 7.8 to 5.6 after prosthetic hand replacement (p-value = 0.018). Negative body evaluation improved from 60.71 ± 12.12 to 53.29 ± 11.03 (p-value = 0.075). Vital body dynamics increased from 38.57 ± 13.44 to 44.43 ± 16.15 (p-value = 0.109). Conclusions Bionic reconstruction provides hope for patients with complete brachial plexopathies who have lived without hand function for years or even decades. Critical patient selection is crucial and the psychosocial assessment procedure including a semi-structured interview helps identify unresolved psychological issues, which could preclude or delay bionic reconstruction. Bionic reconstruction improves overall quality of life, restores an intact self-image and reduces deafferentation pain.
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Affiliation(s)
- Laura Antonia Hruby
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Pittermann
- General Hospital of Vienna, Department of Clinical Psychology, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Health Assisting Engineering, University of Applied Sciences FH Campus, Vienna, Austria
| | - Oskar Christian Aszmann
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Abstract
BACKGROUND Ring avulsion injuries can range from soft tissue injury to complete amputation. Grading systems have been developed to guide treatment, but there is controversy with high-grade injuries. Traditionally, advanced ring injuries have been treated with completion amputation, but there is evidence that severe ring injuries can be salvaged. The purpose of this systematic review was to pool the current published data on ring injuries. METHODS A systematic review of the English literature published from 1980 to 2015 in PubMed and MEDLINE databases was conducted to identify patients who underwent treatment for ring avulsion injuries. RESULTS Twenty studies of ring avulsion injuries met the inclusion criteria. There were a total of 572 patients reported with ring avulsion injuries. The Urbaniak class breakdown was class I (54 patients), class II (204 patients), and class III (314 patients). The average total arc of motion (TAM) for patients with a class I injury was 201.25 (n = 40). The average 2-point discrimination was 5.6 (n = 10). The average TAM for patients with a class II injury undergoing microsurgical revascularization was 187.0 (n = 114), and the average 2-point discrimination was 8.3 (n = 40). The average TAM for patients with a class III injury undergoing microsurgical revascularization was 168.2 (n = 170), and the average 2-point discrimination was 10.5 (n = 97). CONCLUSIONS Ring avulsion injuries are commonly classified with the Urbaniak class system. Outcomes are superior for class I and II injuries, and there are select class III injuries that can be treated with replantation. Shared decision making with patients is imperative to determine whether replantation is appropriate.
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Affiliation(s)
- Ravinder Bamba
- Vanderbilt University, Nashville, TN, USA,Georgetown University, Washington, DC, USA,Ravinder Bamba, Department of Plastic Surgery, Vanderbilt University Medical Center, Vanderbilt University, 1121 21st Avenue S, S-2221, Nashville, TN 37232-2345, USA.
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Morris MT, Daluiski A, Dy CJ. A Thematic Analysis of Online Discussion Boards for Brachial Plexus Injury. J Hand Surg Am 2016; 41:813-8. [PMID: 27311862 DOI: 10.1016/j.jhsa.2016.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/06/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with brachial plexus injury (BPI) and their family members contribute to Internet discussion groups dedicated to BPI. We hypothesized that a thematic analysis of posts from BPI Internet discussion groups would reveal common themes related to the BPI patient experience, providing topics for patient education and counseling. METHODS Internet discussion boards were identified using the search term "brachial plexus injury support group" in Google, Bing, and Yahoo! search engines. Two discussion boards had substantially more posts than other Web sites and were chosen for analyses. Posts from January 1, 2015, through January 1, 2016, were examined. Using an iterative and established process, 2 investigators (M.T.M. and C.J.D) independently analyzed each post using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. In this process, each post was reviewed 3 times. RESULTS A total of 328 posts from the 2 leading discussion boards were analyzed. Investigators reached a consensus on themes for all posts. One central theme focused on emotional aspects of BPI. Four other central themes regarding information support were identified: BPI disease, BPI treatment, recovery after BPI treatment, and process of seeking care for BPI. CONCLUSIONS Examination of posts on Internet support groups for BPI revealed recurring concerns, questions, and opinions of patients and their family members. The most common themes related to disease information, treatment, recovery, and the emotional element of BPI. CLINICAL RELEVANCE These findings provide a helpful starting point in refining topics for patient education and support that are targeted on patients' interests and concerns.
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Affiliation(s)
- Marie T Morris
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St. Louis, MO
| | - Aaron Daluiski
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO.
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Abstract
PURPOSE This study described physical and psychosocial limitations associated with adult brachial plexus injuries (BPI) and patients' expectations of BPI surgery. METHODS During in-person interviews, preoperative patients were asked about expectations of surgery and preoperative and postoperative patients were asked about limitations due to BPI. Postoperative patients also rated improvement in condition after surgery. Data were analyzed with qualitative and quantitative techniques. RESULTS Ten preoperative and 13 postoperative patients were interviewed; mean age was 37 years, 19 were men, all were employed/students, and most injuries were due to trauma. Preoperative patients cited several main expectations, including pain-related issues, and improvement in arm movement, self-care, family interactions, and global life function. Work-related expectations were tailored to employment type. Preoperative and postoperative patients reported that pain, altered sensation, difficulty managing self-care, becoming physically and financially dependent, and disability in work/school were major issues. All patients reported making major compensations, particularly using the uninjured arm. Most reported multiple mental health effects, were distressed with long recovery times, were self-conscious about appearance, and avoided public situations. Additional stresses were finding and paying for BPI surgery. Some reported BPI impacted overall physical health, life priorities, and decision-making processes. Four postoperative patients reported hardly any improvement, four reported some/a good deal, and five reported a great deal of improvement. CONCLUSIONS BPI is a life-altering event affecting physical function, mental well-being, financial situation, relationships, self-image, and plans for the future. This study contributes to clinical practice by highlighting topics to address to provide comprehensive BPI patient-centered care.
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