Rachel Skladman, Caitlin A Francoisse, Allison J L'Hotta, Christine B Novak, Catherine M Curtin, Doug Ota, Katherine C Stenson, Katharine Tam, Carie R Kennedy, Aimee James, Ida K Fox
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Quantitative data from the Spinal Cord Independence Measure (SCIM) and 36-item Short Form Health Survey were collected at baseline and long-term follow-up (6 to 24 months). Qualitative semistructured interview data were also obtained from these participants and their identified caregivers at baseline, early follow-up (1 month), and long-term follow-up (6 to 24 months).</p><p><strong>Results: </strong>Thirty-one participants had quantitative data across all time points: no surgery ( n = 14), TT ( n = 7), and NT ( n = 10). SCIM scores improved in TT and NT groups compared with the no-surgery group ( P < 0.05). The 36-Item Short Form Health Survey scores did not differ among groups. Qualitative data analysis ( n = 168 interviews) corroborated SCIM findings: surgical participants and their caregivers reported improvement in transfers and ability to perform activities of daily living, including grooming and self-catheterization. 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引用次数: 0
摘要
背景:颈脊髓损伤(SCI)是一种破坏性损伤。恢复上肢功能是当务之急,可通过肌腱转移(TT)和神经转移(NT)手术实现。这项前瞻性比较研究旨在通过综合混合方法评估手术组(TT 或 NT)和非手术组上肢功能的长期变化:这项多中心队列研究比较了三组患者的数据:1)未手术组;2)TT 手术组;或 3)NT 手术组。在基线和长期随访(6-24 个月)时收集定量数据,包括脊髓独立性测量(SCIM)和简表健康调查(SF-36)。此外,还在基线、早期随访(1 个月)和长期随访(6-24 个月)时从这些参与者及其确定的照顾者那里获得了半结构化定性访谈数据:31名参与者在所有时间点都获得了定量数据:未接受手术(14人)、TT(7人)和NT(10人)。与未接受手术组相比,TT 组和 NT 组的 SCIM 评分均有所提高(p 结论:TT 和 NT 手术均可提高 SCIM 评分:与未接受手术组相比,TT 和 NT 手术都能带来定量和定性的功能改善。这些比较信息应用于帮助外科医生讨论治疗方案。
Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed-Methods Study.
Background: Cervical spinal cord injury (SCI) has a devastating effect on health and independence. Restoring upper extremity function is a top priority and can be accomplished by tendon transfer (TT) and nerve transfer (NT) surgery. The purpose of this prospective comparative study was to assess long-term changes in upper extremity function between surgical (TT or NT) and nonsurgical groups through a comprehensive mixed-methods approach.
Methods: This multicenter cohort study compared data among 3 groups: those undergoing no surgery, TT surgery, or NT surgery. Quantitative data from the Spinal Cord Independence Measure (SCIM) and 36-item Short Form Health Survey were collected at baseline and long-term follow-up (6 to 24 months). Qualitative semistructured interview data were also obtained from these participants and their identified caregivers at baseline, early follow-up (1 month), and long-term follow-up (6 to 24 months).
Results: Thirty-one participants had quantitative data across all time points: no surgery ( n = 14), TT ( n = 7), and NT ( n = 10). SCIM scores improved in TT and NT groups compared with the no-surgery group ( P < 0.05). The 36-Item Short Form Health Survey scores did not differ among groups. Qualitative data analysis ( n = 168 interviews) corroborated SCIM findings: surgical participants and their caregivers reported improvement in transfers and ability to perform activities of daily living, including grooming and self-catheterization. Improved use of electronics and ability to operate a motor vehicle were also reported. Postoperative therapy was identified as a critical component of achieving gains.
Conclusions: TT and NT surgery lead to quantitative and qualitative functional gains when compared to no surgery. This comparative information should be used to help surgeons discuss treatment options.
Clinical qusetion/level of evidence: Therapeutic, II.
期刊介绍:
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