Using mixed methods to better appreciate the life impact of upper limb reconstruction surgeries for tetraplegia in New Zealand – a study protocol

Background: Until the recent advent of innovative nerve transfer (NT) procedures, upper limb reconstructive surgeries for people with tetraplegia have traditionally involved tendon transfers being performed at a time when neurological recovery had plateaued and the person had returned to live, adapt and acquire new life skills prior to having surgery. This study aims to provide a greater understanding of the process of decision-making for upper limb reconstructive surgical procedures at an early stage prior to full knowledge of life with tetraplegia, as well as the life impacts of surgical arm/hand reconstruction procedures. Methods: A mixed methods convergent design is utilized to allow for the concurrent exploration of narrative data from a case series; and qualitative content analysis of one and quantitative analysis of the two patient-reported outcome measures (PROMs) collected in New Zealand Upper Limb Surgery Registry since 2010. Concurrently, the international classification of functioning, disability and health (ICF) taxonomy is used as the analytical lens to guide data interpretation. Discussion: This study series challenges the conduit role of research and lived experience collaborations for embracing both rehabilitation and disability philosophies to generate and translate knowledge in the SCI field. The designed studies will inform identification of the most relevant therapeutic targets and their measurement, with increased integrity around the ‘person-centred assessment process’ and elaboration of PROMs that reflect that integrity, and are less clinician-directed in terms of content.