| 1. |
- Blomstrand, Johanna, et al.
(författare)
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Pain, hand function, activity performance and apprehensiveness, in patients with surgically treated distal radius fractures
- 2023
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 57:1-6, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- Distal radius fracture (DRF) is a common injury, affecting both function and activity performance. Postoperative rehabilitation is an essential part of the treatment of a surgically treated DRF. The study aims were to assess pain, hand function, activity performance and apprehensiveness and their association, during the first three months after a surgically treated DRF. Eighty-eight patients with a DRF were assessed for pain, hand function, activity performance and apprehensiveness three days and two, six and 12 weeks after surgery. The results indicated that pain, range of motion (ROM), grip strength, apprehensiveness, and activity performance (PRWE) improved significantly between follow-ups (p < .001-.01). Apprehensiveness correlated moderately with activity performance on all visits (0.40-0.47, p < .01), which implies a correlation between the variables, but the regression model showed that the differences in the PRWE at twelve weeks cannot be explained by the differences in apprehensiveness or range of motion at cast removal. At 12 weeks, the study participants had regained almost 70% of their grip strength and 74-96% of the ROM of the uninjured hand. The study shows that, during the study period, the participants improved in both pain, hand function and activity performance, and indicates that a simple question on apprehensiveness in terms of using the injured hand in daily life could be an important factor in distal radius fracture rehabilitation.
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| 2. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Adaptive motor cortex plasticity following grip reconstruction in individuals with tetraplegia
- 2018
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Ingår i: Restorative Neurology and Neuroscience. - : IOS Press. - 0922-6028 .- 1878-3627. ; 36:1, s. 73-82
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tendon transfer is a surgical technique for restoring upper limb motor control in patients with cervical spinal cord injuries (SCI), and offers a rare window into cortical neuroplasticity following regained arm and hand function. Objective: Here, we aimed to examine neuroplasticity mechanisms related to re-established voluntary motor control of thumb flexion following tendon transfer. Methods: We used functional Magnetic Resonance Imaging (fMRI) to test the hypothesis that restored limb control following tendon transfer is mediated by activation of that limb's area of the primary motor cortex. We examined six individuals with tetraplegia who underwent right-sided surgical grip reconstruction at Sahlgrenska University Hospital, Sweden. All were right-handed males, with a SCI at the C6 or C7 level, and a mean age of 40 years (range = 31-48). The average number of years elapsed since the SCI was 13 (range = 6-26). Six right-handed gender-and age-matched control subjects were included (mean age 39 years, range = 29-46). Restoration of active thumb flexion in patients was achieved by surgical transfer of one of the functioning elbow flexors (brachioradialis), to the paralyzed thumb flexor (flexor pollicis longus). We studied fMRI responses to isometric right-sided elbow flexion and key pinch, and examined the cortical representations within the left hemisphere somatomotor cortex a minimum of one year after surgery. Results: Cortical activations elicited by elbow flexion did not differ in topography between patients and control participants. However, in contrast to control participants, patients' cortical thumb flexion activations were not topographically distinct from their elbow flexion activations. Conclusion: This result speaks against a topographic reorganization in which the thumb region regains thumb control following surgical tendon transfer. Instead, our findings suggest a neuroplastic mechanism in which motor cortex resources previously dedicated to elbow flexion adapt to control the thumb.
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| 3. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Essential gains and health after upper-limb tetraplegia surgery identified by the International classification of functioning, disability and health (ICF)
- 2017
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 55:9, s. 857-863
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: A questionnaire-based survey. Objectives: To describe functional gains and health following upper-limb tetraplegia surgery using the International Classification of Functioning, Disability and Health (ICF) as a reference and to explore interconnections across different dimensions of functioning and health. Setting: A specialized center for advanced reconstruction of extremities at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: Fifty-seven individuals who participated in a satisfaction survey were included in the present study. Besides questions concerned with the respondents' satisfaction with different aspects of surgery, the measures included perceived overall health status (EQ-VAS) and achieved grip strength. Univariate analyses were used to explore interconnections between measures. Results: The gains could be subcategorized and linked to the ICF domains 'mobility', 'self-care', 'communication', 'domestic life', and 'community, social and civic life', with 'handling objects' and 'maneuvering a wheelchair' as the most frequently reported gains. The mean EQ-VAS score was 67 +/- 22. No significant correlation was shown between grip strength and activity gains, nor between grip strength and perceived overall health. The degree of satisfaction was, however, associated with self-reported overall health among participants. Conclusion: The functional gains achieved after tetraplegia surgery could be applied to the ICF constructs' body functions/structures and activity with possible implications on participation. The overall health perception was relatively high and could be linked to the degree of satisfaction among participants. Muscle strength is not necessarily transferable to activity performance. This emphasizes the importance of addressing factors other than strength in the post-surgical rehabilitation and assessments.
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| 4. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Feasibility of using fNIRS to explore motor-related regional haemodynamic signal changes in patients with sensorimotor impairment and healthy controls: A pilot study
- 2023
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Ingår i: Restorative Neurology and Neuroscience. - 0922-6028 .- 1878-3627. ; 41:3-4, s. 91-101
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Tidskriftsartikel (refereegranskat)abstract
- Background: While functional near-infrared spectroscopy (fNIRS) can provide insight into cortical brain activity during motor tasks in healthy and diseased populations, the feasibility of using fNIRS to assess haemoglobin-evoked responses to reanimated upper limb motor function in patients with tetraplegia remains unknown. Objective: The primary objective of this pilot study is to determine the feasibility of using fNIRS to assess cortical signal intensity changes during upper limb motor tasks in individuals with surgically restored grip functions. The secondary objectives are: 1) to collect pilot data on individuals with tetraplegia to determine any trends in the cortical signal intensity changes as measured by fNIRS and 2) to compare cortical signal intensity changes in affected individuals versus age-appropriate healthy volunteers. Specifically, patients presented with tetraplegia, a type of paralysis resulting from a cervical spinal cord injury causing loss of movement and sensation in both lower and upper limbs. All patients have their grip functions restored by surgical tendon transfer, a procedure which constitutes a unique, focused stimulus for brain plasticity. Method: fNIRS is used to assess changes in cortical signal intensity during the performance of two motor tasks (isometric elbow and thumb flexion). Six individuals with tetraplegia and six healthy controls participate in the study. A block paradigm is utilized to assess contralateral and ipsilateral haemodynamic responses in the premotor cortex (PMC) and primary motor cortex (M1). We assess the amplitude of the optical signal and spatial features during the paradigms. The accuracy of channel locations is maximized through 3D digitizations of channel locations and co-registering these locations to template atlas brains. A general linear model approach, with short-separation regression, is used to extract haemodynamic response functions at the individual and group levels. Results: Peak oxyhaemoglobin (oxy-Hb) changes in PMC appear to be particularly bilateral in nature in the tetraplegia group during both pinch and elbow trials whereas for controls, a bilateral PMC response is not especially evident. In M1 / primary sensory cortex (S1), the oxy-Hb responses to the pinch task are mainly contralateral in both groups, while for the elbow flexion task, lateralization is not particularly clear. Conclusions: This pilot study shows that the experimental setup is feasible for assessing brain activation using fNIRS during volitional upper limb motor tasks in individuals with surgically restored grip functions. Cortical signal changes in brain regions associated with upper extremity sensorimotor processing appear to be larger and more bilateral in nature in the tetraplegia group than in the control group. The bilateral hemispheric response in the tetraplegia group may reflect a signature of adaptive brain plasticity mechanisms. Larger studies than this one are needed to confirm these findings and draw reliable conclusions.
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| 5. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire.
- 2017
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 55, s. 664-671
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Tidskriftsartikel (refereegranskat)abstract
- A questionnaire-based survey.To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire.A center for advanced reconstruction of extremities, Gothenburg, Sweden.Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling.Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test-retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities.Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.Spinal Cord advance online publication, 21 February 2017; doi:10.1038/sc.2017.12.
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| 6. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Surgical restoration of hand function in tetraplegia
- 2021
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Ingår i: Spinal Cord Series and Cases. - : Springer Science and Business Media LLC. - 2058-6124. ; 7
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Dunn, J. A., et al.
(författare)
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Grasp and Release Test for Tetraplegic Hand Assessment: an update of the Grasp and Release Test
- 2023
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Ingår i: Spinal Cord. - 1362-4393. ; 61:8, s. 466-468
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Tidskriftsartikel (refereegranskat)abstract
- The Grasp and Release Test (GRT) was originally developed to measure effectiveness of an implanted neuroprosthesis in people with tetraplegia. Its ease of use and lack of floor and ceiling effects culminated in recommendations for inclusion in a battery of tests to measure outcome following upper limb reconstructive surgery. However, the length of time taken to administer the GRT in a clinical setting, lack of instructions of accepted grasp patterns in the upper limb reconstructive surgery population and scoring procedures lead to differences in reporting outcomes using this measure. In order to ensure clinical utility for the upper limb reconstructive surgery population, revisions of the original test instructions have been made and are reported in this article. Further testing of the psychometric properties of the new measure are currently underway.
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| 8. |
- Dunn, Jennifer Anne, 1970, et al.
(författare)
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Improving upper limb function
- 2020
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Ingår i: Rehabilitation in Spinal Cord Injuries. - : Elsevier Health Sciences. - 9780729587600
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Bokkapitel (refereegranskat)abstract
- Improved upper limb function is identified as the most important function to regain by people with tetraplegia following spinal cord injury (SCI). Hand function is important not only for independence in daily life, but social and psychological factors are dependent on hand function. This chapter gives an overview on both conservative treatments strategies and reconstructive arm- and hand surgery and rehabilitation available for this patient group.
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| 9. |
- Dunn, Jennifer A, et al.
(författare)
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Toward Consensus in Assessing Upper Limb Muscle Strength and Pinch and Grip Strength in People With Tetraplegia Having Upper Limb Reconstructions.
- 2021
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Ingår i: Topics in spinal cord injury rehabilitation. - : American Spinal Injury Association. - 1945-5763 .- 1082-0744. ; 27:3, s. 70-82
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Tidskriftsartikel (refereegranskat)abstract
- To reach agreement on standardized protocols for assessing upper limb strength and grip and pinch force for upper limb reconstructive surgery for tetraplegia.Selected members of an expert panel composed of international therapists formed at the 2018 International Congress for Upper Limb Surgery for Tetraplegia conducted a literature review of current practice that identified gaps and inconsistencies in measurement protocols and presented to workshop attendees. To resolve discrepancies, a set of questions was presented to workshop attendees who voted electronically. Consensus was set at 75% agreement.For manual muscle testing, consensus was reached for using the Medical Research Council scale, without plus or minus, and the use of resistance through range when testing grade 4 and grade 5 strength. Pectoralis major and serratus anterior should be routinely tested, however there was no consensus on other shoulder muscles. Grip and pinch strength should be tested according to the American Society of Hand Therapists positioning. For grip strength, either the Jamar or Biometrics dynamometer expressed in kilograms should be used. For grip and pinch strength, three measurements should be performed at each testing. No consensus was reached on a device for pinch strength.This work is an important step to enable comparable data in the future. Further consensus methods will work toward developing more comprehensive guidelines in this population. Building international consensus for pre- and postoperative measures of function supports objective evaluation of novel therapies and interpretation of multicenter studies.
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| 10. |
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| 11. |
- Fridén, Jan, 1953, et al.
(författare)
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Upper extremity reconstruction in non-traumatic spinal cord injuries: An under-recognized opportunity.
- 2014
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 46:1, s. 33-8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study reviews the usefulness of surgical improvement of arm and hand function in patients with non-traumatic spinal cord injury who differ significantly from individuals with post-traumatic tetraplegia with respect to age, injury pattern, gender and socio-economic factors. Design: Case series. Tests were conducted preoperatively and 12 months postoperatively. Patients: The results of 14 upper extremity reconstructions in 11 patients (7 women, 4 men) with spinal cord injury, mean age at injury 49 years (standard deviation (SD) 12), were reviewed. Methods: Key pinch strength, grip strength and first web space opening were recorded pre- and post-operatively in all patients, 5 patients (7 hands) were evaluated prospectively regarding manual dexterity. Results: All parameters were significantly improved. Strength of key pinch increased from 0.3 kg in 1 case and zero in 10 cases to a mean of 1.6 kg (SD 0.9). Mean grip strength increased from 0 to 3.2 kg (SD 4.5). Maximal distance between thumb and index increased from 2.1 cm (SD 4.1) to 6.4 cm (SD 4.4). Manual dexterity increased. Conclusion: Individuals with stable non-traumatic tetraplegia benefit from surgical rehabilitation of their upper extremities. The number of non-traumatic spinal cord injuries is likely to increase as lifespan increases worldwide, and further research into the functional rehabilitation of this population will therefore become increasingly relevant.
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| 12. |
- Koch-Borner, S., et al.
(författare)
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Rehabilitation After Posterior Deltoid to Triceps Transfer in Tetraplegia
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 97:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe and evaluate the rehabilitation concept after posterior deltoid to triceps transfer in patients with tetraplegia. Participants: Patients with tetraplegia who had posterior deltoid to triceps tendon transfer and had muscle strength measurements 1 year postsurgery from 2009 to 2013 (N=44). Interventions: Posterior deltoid to triceps tendon transfer to restore elbow extension and postoperative rehabilitation. Main Outcome Measures: Elbow extension range of motion and muscle strength and the modified Canadian Occupational Performance Measure (COPM). Results: Surgery was performed on 53 arms. No major complications (eg tendon rupture, lengthening) were reported. Muscle strength measured 1 year after surgery was on average grade 3 (out of 5) in the 53 operated arms. The ability to extend the elbow against gravity was achieved in 62% of the arms (muscle strength of grade >= 3). In patients with a preoperative elbow extension deficit (n=14), the deficit was reduced on average from 16 degrees to 9 degrees. The performance of the prioritized activities as measured with the COPM improved on average 2.6 scale steps, from 3.3 to 5.9. Satisfaction with the performance improved on average 3.2 scale steps, from 2.8 to 6.0. Conclusions: The posterior deltoid to triceps tendon transfer with the applied rehabilitation protocol is a safe and effective procedure. There were no tendon ruptures, and all patients were able to complete the rehabilitation protocol. The shorter restriction time after surgery allows the patient to be independent at an earlier stage of the rehabilitation and reduces hospitalization or care burden. (C) 2016 by the American Congress of Rehabilitation Medicine
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| 13. |
- Melin, jeanette, et al.
(författare)
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Knowledge translation gaps that need to be bridged to enhance life for people with spinal cord injury.
- 2024
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Ingår i: Spinal cord series and cases. - : Springer Nature. - 2058-6124. ; 10:5, s. 570-577
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Mixed-method consensus development project. Objective: To identify the top ten research priorities for spinal cord injury (SCI). Setting: Nationwide in Sweden in 2021-22. Methods: The PSP process proposed by the James Lind Alliance was used. It comprises two main phases: question identification and priority selection. People living with SCI, relatives of people with SCI as well as health professionals and personal care assistants working with people with SCI were included. Results: In the first phase, 242 respondents provided 431 inputs addressing potentially unanswered questions. Of these, 128 were beyond the scope of this study. The remaining 303 were merged to formulate 57 questions. The literature review found one question answered, so 56 questions proceeded to the prioritisation. In the second phase, the interim prioritisation survey, 276 respondents ranked the 56 questions. The top 24 questions then proceeded to the final prioritisation workshop, at which 23 participants agreed on the top ten priorities. Conclusions: This paper reveals issues that people living with SCI, relatives of people with SCI as well as health professionals and personal care assistants working with people with SCI find difficult to get answered. The top-priority questions for people living with SCI in Sweden concern specialist SCI care and rehabilitation, followed by a number of questions addressing physical health. Other topics, from the 56 key questions include Mental health, Ageing with SCI, Community support and personal care assistance, and Body functions. This result can guide researchers to design appropriate studies relevant to people with SCI.
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| 14. |
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| 15. |
- Ramström, Therese, et al.
(författare)
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Arm activity measure (ArmA): psychometric evaluation of the Swedish version
- 2021
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer Science and Business Media LLC. - 2509-8020. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Patient Reported Outcomes Measure (PROM) are commonly used in research and essential to understand the patient experience when receiving treatment. Arm Activity Measure (ArmA) is a valid and reliable self-report questionnaire for assessing passive (section A) and active (section B) real-life arm function in patients with disabling spasticity. The original English version of ArmA has been psychometrically tested and translated into Thai. Aims Translate and cross-culturally adapt ArmA to Swedish language and context. Further, to evaluate the reliability, validity and sensitivity of the Swedish version of the questionnaire (ArmA-S) in patients with disabling upper limb spasticity caused by injuries to the central nervous system (CNS). Materials and methods ArmA was translated and cross-culturally adapted according to established guidelines. Validity and reliability were evaluated in 61 patients with disabling spasticity. Face and content validity was evaluated by expert opinions from clinicians and feedback from patients with upper limb spasticity. Internal consistency reliability was assessed with Cronbach's alpha and test-retest reliability was assessed using the quadratic weighted kappa. Results ArmA-S was shown to be clinically feasible, with good face and content validity and no floor or ceiling effects. Internal consistency of ArmA-S was high and equivalent to ArmA; with Chronbach ' s alpha coefficients values of 0.94 and 0.93 for section A and B, respectively. Test-retest reliability was good, with kappa values of 0.86 and 0.83 for section A and B, respectively. Some layout modifications of ArmA-S were made to further increase the user-friendliness, test-retest reliability, and responsiveness. Conclusion ArmA-S was shown to be a reliable and valid self-report questionnaire for use in clinical practice and research to assess improvements in passive and active upper limb function in patients with disabling spasticity.
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| 16. |
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| 17. |
- Ramström, Therese, et al.
(författare)
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Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health
- 2022
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Ingår i: Occupational Therapy International. - : Hindawi Limited. - 0966-7903 .- 1557-0703. ; 2022
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Tidskriftsartikel (refereegranskat)abstract
- Background. Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks. Objectives. The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength. Methods. In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation. Results. 60 patients with a history of spinal cord injury (SCI) (n=42; 59%), stroke (n=25; 34%), traumatic brain injury (TBI) (n=4; 6%), and reason unknown (n=1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care (n=131; 41%), domestic life (n=68; 21%), and mobility (n=58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown. Conclusion. Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.
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| 18. |
- Ramström, Therese, et al.
(författare)
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Spasticity-correcting surgery can have long-lasting effects
- 2023
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Ingår i: Lakartidningen. - 1652-7518. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- Spasticity is a common secondary complication after injuries to the central nervous system (CNS). Spasticity may severely impair arm and hand function, and consequently, affect an individual's function, resulting in disabilities or limiting activities and participation. Today, there is conflicting evidence regarding the effectiveness of available spasticity treatments. The population of adults with spasticity problems due to a CNS injury is heterogenic. A multidisciplinary approach is essential in customizing treatment to individual needs. The planning of treatment should consider the remaining upper limb functions and the patient's potential to improveme. Spasticity-correcting surgery is an option that seems underutilized. This article describes a structured and standardized program for the preoperative assessment, the surgical technique and the postoperative rehabilitation of patients undergoing upper limb spasticity-correcting surgery.
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| 19. |
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| 20. |
- Ramström, Therese, et al.
(författare)
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The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis
- 2022
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:21, s. 6295-6303
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to explore the patient perspective of their experiences of daily life after spasticity-correcting surgery for disabling upper limb (UL) spasticity after spinal cord injury (SCI) and stroke. Materials and methods Eight patients with UL spasticity resulting from SCI (n= 6) or stroke (n= 2) were interviewed 6-9 months after spasticity-correcting surgery. A phenomenographic approach was used to analyze the interviews. Results Five themes emerged from the interviews: (1) bodily changes, such as increased muscle strength, range of motion, and reduced muscle-hypertonicity; (2) improved occupational performance, facilitating tasks, mobility, and self-care; (3) regained control, explicating the perception of regaining bodily control and a more adaptable body; (4) enhanced interpersonal interactions, entailing the sense of being more comfortable undertaking social activities and personal interactions; and (5) enhanced psychological well-being, including having more energy, increased self-esteem, and greater happiness after surgery. Conclusions The participants experienced improvements in their everyday lives, including body functions, activities, social life, and psychological well-being. The benefits derived from surgery made activities easier, increased occupational performance, allowed patients regain their roles and interpersonal interactions, and enhanced their psychological well-being.
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| 21. |
- Reinholdt, Carina, 1968, et al.
(författare)
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Spasticity-reducing surgery – strategies
- 2018
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Ingår i: Tetrahand congress, Swiss Paraplegic Center, Notwill, Switzerland.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Sinnott, K. Anne, et al.
(författare)
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Measurement of outcomes of upper limb reconstructive surgery for tetraplegia.
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 97:6, s. S169-S181
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 by the American Congress of Rehabilitation Medicine.Reconstructive arm/hand surgery for tetraplegia is performed to improve arm/hand function and therefore personal well-being for individuals who accept such elective surgeries. However, changes at an impairment level do not always translate into functional or quality of life changes. Therefore, multiple outcome tools should be used that incorporate sufficient responsiveness to detect changes in arm/hand function, activity and participation, and quality of life of the individuals involved. This narrative review aims to assist clinicians to choose the most appropriate tools to assess the need for reconstructive surgery and to evaluate its outcomes. Our specific objectives are (1) to describe aspects to consider when choosing a measure and (2) to describe the measures advised by an international therapist consensus group established in 2007. All advised measures are appraised in terms of the underlying construct, administration, and clinical relevance to arm/hand reconstructions. Essentially there are currently no criterion standard measures to evaluate the consequences of reconstructive arm/hand surgery. However, with judicious use of available measures it is possible to ensure the questions asked or tasks completed are relevant to the surgical reconstruction(s) undertaken. Further work in this field is required. This would be best met by immediate collaboration between 2 outcome's tool developers and by analysis of pre- and postoperative data already held in various international sites, which would allow further evaluation of the measures already in use, or components thereof.
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| 23. |
- Svantesson, Eleonor, et al.
(författare)
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The combination of nerve and tendon transfers offers good possibilities for hand function in patients with cervical spinal cord injury : Så kan funktion i hand och arm återfås efter halsryggmärgsskada. Bättre funktion om nerv- och sentransfereringar kombineras
- 2022
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Ingår i: Läkartidningen. - 1652-7518. ; 119
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Tidskriftsartikel (refereegranskat)abstract
- Regaining upper extremity function is a prioritized matter for patients with tetraplegia after a cervical spinal cord injury (cSCI). The purpose of this article is to describe the current evidence and treatment strategies for upper extremity reconstruction after cSCI at the Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Sweden. The specialized unit works in a multidisciplinary setting to optimize the care of the patient population. Preoperative planning and an individualized treatment according to the needs and abilities of the patient are considered key points to achieve the best possible outcome. The addition of nerve transfers to the established method of tendon transfers for grip reconstruction has led to increased possibilities to achieve both functional hand opening and grip. Here we present our preferred method of upper extremity reconstruction, which involves a two-staged procedure where the tendon-based grip reconstruction is preceded by nerve transfer of the supinator to posterior intraosseous nerve whenever possible. Important clinical aspects as well as future perspectives are discussed.
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| 24. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Activity Gains After Reconstructions of Elbow Extension in Patients With Tetraplegia.
- 2012
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Ingår i: The Journal of hand surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 37:5, s. 1003-1010
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Reconstruction of triceps function in persons with tetraplegia is an established surgical intervention. The purpose of this study was to investigate and evaluate patient perspective of gains in activity and satisfaction after surgical reconstruction of triceps function and subsequent rehabilitation. METHODS: We studied the effects of surgery and rehabilitation in 14 persons (19 arms) treated with deltoid-to-triceps transfer. We used Canadian Occupational Performance Measurement standards to capture the performance and satisfaction of patient-identified activity goals. Follow-up was performed at 6 and 12 months postoperatively. To make group analyses, we classified activity goals according to the International Classification of Function, Disability, and Health categories of activities and participation, as well as relative to the position of the arm in space. RESULTS: Patients reported improvement in performance after surgery, and satisfaction was rated even higher. Improvement was seen in all types of activities that patients had prioritized. No single goal was rated lower at 12 months' follow-up than before surgery. The most common activity gains were related to "driving a wheelchair" and the ability to "reach out," each of which represented 20% of expressed goals. Although "driving a wheelchair" and "moving the body" (transfers) were common goals, the smallest improvements for both performance and satisfaction after 12 months were seen in these areas. We observed the highest performance improvement in the category of "writing" and the ability to "stretch out the arm when lying down." CONCLUSIONS: Improvement in activity continues over the first year after triceps reconstruction. Complex activities continue to improve over a longer period than simpler activities. We saw the highest improvement in activities performed without the aid of gravity and activities highly dependent on coordination. Such actions are difficult to compensate for by technique or skills, and therefore elbow extension is essential for performance. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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| 25. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Activity gains after upper limb surgery for spasticity in patients with spinal cord injury
- 2018
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Ingår i: Journal of Hand Surgery-European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 43:6, s. 613-620
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Tidskriftsartikel (refereegranskat)abstract
- Spasticity is a common and increasingly prevalent secondary complication of spinal cord injury. The aim of the study was to evaluate patient-experienced gains in prioritized activities after surgery to reduce the effects of spasticity in upper limbs in tetraplegia. The study includes evaluation of 30 operations for 27 patients performed on hypertonic tetraplegic hands during 2007-2015 using the Canadian Occupational Performance Measure. Activity performance increased at both 6 months and 12 months by a mean of 3.0 and 2.9 points, respectively. Satisfaction increased by 3.3 and 3.4, respectively. All types of activities improved, with wheelchair manoeuvring as one of the highest rated. The intervention increased prioritized activity performance and persisted at least 12 months after surgery. Patients with mild upper limb impairment showed greater improvement after surgery. After operation, patients were able to perform 71% of their prioritized activities, which they could not perform before. Patients' satisfaction with the performance was high. Level of evidence: IV
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| 26. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Development, Internal Construct, and Unidimensionality of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 1
- 2022
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 103:11, s. 2189-2196
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aims to develop a patient-reported outcome measure that focuses on relevant daily activities relying on upper extremity for individuals with tetraplegia. Design: Cross-sectional study. Setting: Spinal cord injury units in 2 countries. Participants: Ninety-nine individuals (N=99) with C2-C8, American Spinal Injury Association Impairment Scale A-D tetraplegia, mean age 46 years, 1- 43 years post injury. Interventions: Thirteen items included in the initial testing were chosen from 708 activity limitations identified by individuals with tetraplegia. Items were pilot tested for wording, response options, and relevance for both performance and satisfaction. Items were analyzed and reselected using exploratory factor analysis and Rasch analysis for local dependency, dimensionality, differential item functioning (DIF), threshold response, and targeting. Main Outcome Measures: Not applicable. Results: Exploratory factor analysis supported a 2-factor solution for both performance and satisfaction. While data fit the Rasch model, there was evidence of local dependency and multiple disordered thresholds. Three items were removed because of high interitem correlation and DIF and the scale rescored to 5 response options. The remaining 10 items demonstrated fit to the Rasch model, with no local dependency, no multidimensionality, no item or person misfit, and minimal disordered thresholds. Conclusions: Results support the internal construct validity and unidimensionality of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a 10-item, 5-response patient-reported outcome measure assessing performance and satisfaction with activities targeted to the upper extremity for individuals with tetraplegia. Further testing is required and ongoing to evaluate reliability and responsiveness of the TUAQ. © 2022 The Authors
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| 27. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 97:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe and evaluate the concept of early active rehabilitation after tendon transfer to restore grip function in tetraplegia. Participants: All patients with tetraplegia who underwent tendon transfer to restore grip ability during 2009 to 2013 (N=49). Intervention: Reconstructive tendon transfer surgery with early active rehabilitation to restore grip ability in tetraplegia. Main Outcome Measures: Grip and pinch strength, grip ability test, and outcome of prioritized activities. Results: In the 49 surgeries performed, postoperative complications included 2 patients with bleeding and 2 infections related to the surgery. There were no reported ruptures or lengthening of transferred tendons. Within 24 hours after surgery, all 47 patients (100%) with finger flexion reconstruction succeeded to activate their finger flexion. All but 1 patient with reconstructed thumb flexion sucessfully activated their thumb flexion (n=40). Three weeks after surgery, all patients (100%) were able to perform basic activities of daily living, and instrumental activities of daily living were achieved by 74%. One year after surgery, the maximum grip strength in restored finger flexion was on average 6.9kg (range, 1.5-15kg; n=29). The maximum pinch strength in restored thumb flexion was on average 3.7kg (range, 1-20; n=29). On average, grip ability improved from 33 to 101 (n=19) according to the COPM. Prioritized activity limitations, as measured with the COPM, equated to an average of 3.5 steps (2.5 steps preoperatively to 6 steps postoperatively): Patients' perceived satisfaction with this improvement was 4 steps (increasing from 2 steps preoperatively to 6 steps postoperatively). Conclusions: Grip reconstructive surgery followed by early active rehabilitation can be considered a reliable procedure that leads to substantial improvements in grip and pinch strength and activity performance among patients with tetraplegia. (C) 2016 by the American Congress of Rehabilitation Medicine
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| 28. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Enhanced independence: experiences after regaining grip function in people with tetraplegia.
- 2013
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 35:23, s. 1968-1974
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose: To explore how surgical reconstruction of grip affects everyday life for patients with tetraplegia, with special emphasis on patients perspective of their perceived changes. Design: Qualitative method. Subjects: Eleven people (aged 22-73) with tetraplegia who had undergone surgical reconstruction to restore grip function. Methods: Qualitative interviews were conducted 7-17 months after surgery and analysed using Grounded theory. Results: The core concept describing the participants experienced gains after grip reconstructive surgery was "enhanced independence". It was associated with changes in both practical and psychological aspects of independence. Practical aspects identified were: "perform more activities", "smoother everyday life", "renewed ability to participate in social activities", "less dependence on assistance" and "less restricted by physical environment". Psychological aspects of independence included "regained privacy", "increased manageability", "regained identity", "recapture a part of the body" and "share positive experiences with relatives and friends". Encompassing all categories was the concept "self-efficacy in hand control". It was seen as a result included in the enhanced independency core but also as an important factor for the development of all the other categories. Conclusion: Participants in this study experienced enhanced independence after grip reconstructive surgery and rehabilitation. The enhanced independence included both practical and physical aspects and it influenced all domains using the International Classification of Function, Disability and Health model; body function and structure, activities, participation, personal factors and environmental factors. Implications for Rehabilitation Patients with tetraplegia experience grip reconstruction as a useful intervention, an enhanced independence, related to their improved hand control. The increased hand control impacted not only physical aspects but also practical and psychological aspects. It also influenced social and community participation and the interference the environment had on the person. Self-efficacy was both a result of the intervention and a catalyst allowing the subcategories to develop. Therefore, self-efficacy in hand control seems to be an important factor to focus on during the rehabilitation process.
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| 29. |
- Wangdell, Johanna, 1971, et al.
(författare)
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From regained function to daily use: experiences of surgical reconstruction of grip in people with tetraplegia.
- 2014
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 36:8, s. 678-684
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose: To capture patients' relearning processes from regained function to improvements in daily life after grip reconstructive surgery in tetraplegia. Subjects: Eleven people with tetraplegia who underwent grip reconstructive surgery during February 2009 to March 2011. Methods: Qualitative interviews were conducted 7 to 17 months after surgery and analysed using grounded theory. Results: Determination to reach a higher level of independence was the core concept to integrate regained function into daily life. There were 3 phases identified; "Initiate activity training," "Establish hand control in daily activities," and "Challenge dependence." Between the phases psychological stages occurred, first; "a belief in improved ability", and later in the process; "confidence in ability". The process to fully integrate regain function in daily life was described as long and time-consuming. However, the participants claimed it useful to do the skills training in their home environment, without long-term in clinic rehabilitation. Conclusion: Relearning activities in daily life after a grip reconstruction is a time-consuming and demanding process. It includes skills training, mental strategies and psychological stages together with environmental and social factors. Accordingly, rehabilitation after grip reconstruction in tetraplegia should focus on both grip skills and psychological stages, to encourage that patient's keep their determination and achieve greater independence. Implications for Rehabilitation There is a stepwise process to transform improved function into daily use. The most important factor to transform improved function into daily use was motivation to reach a higher independence. Other important factors were; skills training, use of individual learning strategies, belief and confidence in personal ability, social and environmental factors. There was a long and demanding process to fully transform the improved function into daily use. The participants preferred to do activity training in the specific environment, usually at home.
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| 30. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Outcomes of reconstructive hand surgery in patients with tetraplegia and neuropathic pain.
- 2018
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 56, s. 1194-1198
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Tidskriftsartikel (refereegranskat)abstract
- Retrospective cohort study OBJECTIVES: To evaluate the impact of preoperative neuropathic pain on outcome and postoperative compliance after grip reconstructive surgery in people with tetraplegia.Specialized tetraplegia upper-limb surgery center in Sweden.All patients who underwent grip reconstructive surgery and attended a 6 month follow up during January 2012 and May 2015 were included. Participants were divided into two groups, pain group and no pain group, based on preoperative rating of experienced pain on a visual analog scale. The main outcome measures were grip strength, grasp ability (Grasp and Release Test) and prioritized activity outcome (Canadian Occupational Performance Measure) together with compliance to the rehabilitation plan.The study include 37 patients (86% of the cohort). Seventeen patients experienced preoperative pain (46%). There were no differences in outcome between the pain- and the no pain group regarding grip strength (5 vs. 4.6kg), grip ability or activity performance and satisfaction (COPM improvement of 3.1 vs. 3.0 for performance and 3.6 for both groups in satisfaction). Both groups experienced improvements in all aspects and there were no differences in the ability to fulfill postoperative treatment.Individuals with tetraplegia and preoperative neuropathic pain in the arm/hand improve after grip reconstructions in a similar way to those without pain. Patients with neuropathic pain therefore should be considered as surgery candidates to the same extent as those without pain.
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| 31. |
- Wangdell, Johanna, 1971
(författare)
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Patients' perceived outcomes in tetraplegia hand surgery
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To investigate patients perceived benefits after upper limb surgery in persons with tetraplegia - with a special focus on the participants’ perspective and their experiences from regaining lost functions. Methods: A combined Quantitative and Qualitative design was used. The outcome measures in study I and III was the Canadian Occupational Performance Measure (COPM). It captured patients perceived performance and satisfaction with their prioritized activities. Study II was a correlation study between activity gains and physical factors. Study IV and V used a grounded theory approach to capture patients experiences regarding a) changes in their daily life and b) the transformation process of regained function into daily use. Patients were recruited from National center of Reconstructive hand surgery in tetraplegia, Sahlgrenska University Hospital, Sweden. Patients came from diverse parts of the Nordic countries. Results: Patients set up goals relevant to the specific surgery, they experience improvements and were satisfied with the performance of their prioritized goals. All types of goals improved after grip reconstruction, especially eating and goals generally regarded as more complex ea domestic life and leisure activities. The satisfaction was similar to the performance improvements. When the patients expressed their experienced after surgery the core theme was “enhanced independence” including both practical and psychological aspects and an increased self-efficacy in their hand control. No correlation between a single physical factor and perceived improvement in activity was found, suggesting there are also other factors relevant for the transformation process to use regained function in daily life. “Determination for higher independence” was the core concept to transform the function into daily use, described by the participants. Time, training in home environment and social support was other important factors. In the process “belief in ability” and later “confident in ability” were important stages to proceed further into daily use. Discussion: Reconstructive hand surgery and rehabilitation are shown to have impact in many dimensions in life and it gives reflexions in all domains of the International Classification of Functioning, Disability and Health (ICF) model; body structures and function, activity, participation, personal factors and environmental factors. A carefully informed and highly motivated patient is important to receive a good result, not only in grip strength but also in all the other domains of ICF. No single physical factor known before surgery, e.g. sensibility or age could alone explain improvements in prioritized activities. Traditional limitations with high age and lack of sensibility could not be proven to be a limitation to activity improvement in present study. Therefore, all patients with tetraplegia should have the opportunity to choose to have hand surgery. Neither could grip strength alone demonstrate a correlation with activity improvements. Physical factors have of course an important impact on the capability in activity performance but in agreement with the ICF model, personal and environmental factors also plays an important role in activity and participation improvements after reconstructive hand surgery in tetraplegia. Accordingly, body functions, activity and participation all should receive attention in the rehabilitation after surgery and also the need for evaluations in the diverse dimensions to capture multiple perspectives of changes after surgery. Conclusion: Reconstructive hand surgery is a useful and valuable intervention for people with tetraplegia. The participants experienced an increased hand control that had impact not only on physical aspects but also in participation, practical and psychological aspects. Together with the physical improvement, high motivation and development of self-efficacy in hand control seems, from the results of these studies, to be important factors to secure activity and participation improvements after surgery.
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| 32. |
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| 33. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Performance of prioritized activities is not correlated with functional factors after grip reconstruction in tetraplegia.
- 2011
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 43:7, s. 626-630
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the correlation between perceived performance in prioritized activities and physical conditions related to grip reconstruction. Design: Retrospective clinical outcome study. Patients: Forty-seven individuals with tetraplegia were included in the study. Each participant underwent tendon transfer surgery in the hand between November 2002 and April 2009 and had a complete 1-year follow-up. Methods: Functional characteristics and performance data were collected from our database and medical records. Patients’ perceived performances in prioritized activities were recorded using the Canadian Occupational Performance Measurement. Preoperative data included age at surgery, time since injury, severity of injury, sensibility and hand dominance. At 1-year follow-up, grip strength, key pinch strength, finger pulp-to-palm distance, distance between thumb and index finger and wrist flexion were measured. Correlation rank coefficient was used to test the possible relationship between physical data and activity performance. Results: There were improvements in both functional factors and in rated performance of prioritized activities after surgery. There was no correlation between performance change and any of the physical functions, the factors known before surgery, or the functional outcome factors. Conclusion: No correlation exists between a single functional outcome parameter and the patients’ perceived performance of their prioritized goals in reconstructive hand surgery in tetraplegia.
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| 34. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Rehabilitation after grip reconstruction
- 2016
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Ingår i: Reconstructive Surgery and Rehabilitation of the Tetrapelgic Upper Extremity. - Bergen and Gothenburg. - 9788299687171
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 35. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Rehabilitation after nerve transfer
- 2016
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Ingår i: Reconstructive Surgery and Rehabilitation of the Tetrapelgic Upper Extremity. - Bergen and Gothenburg. - 9788299687171
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 36. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Rehabilitation After Spasticity-Correcting Upper Limb Surgery in Tetraplegia
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 97:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the early active rehabilitation concept developed for spasticity-correcting surgery in tetraplegia and to report the outcomes in grip ability and change of performance and satisfaction in patients' prioritized activities 1 year postoperatively. Participants: All patients who underwent surgeries for correction of spasticity in tetraplegic hands between 2009 and 2013 in the studied unit (N=37). Interventions: Spasticity-correcting upper limb surgery with early active rehabilitation to restore grip ability in tetraplegia. Main Outcome Measures: Grasp and release test (GRT) and modified Canadian Occupational Performance Measure (COPM). Results: All patients could accomplish the early active rehabilitation concept. The complication rate related to the treatment was low. Compared with preoperatively, all evaluated individuals experienced improvements in grasp ability and activity performance and satisfaction at 1-year follow-up. The performance in prioritized activities, as measured by the COPM, improved by 2.6 scale steps. Satisfaction with performance improved 3.0 scale steps postoperatively (n=21). The grasp ability, measured by the GRT, improved significantly, from 80 preoperatively to 111 (n=10). Conclusions: The surgery, combined with the early active rehabilitation protocol, is a reliable and safe procedure. The ability to use the hand improved, and gains were maintained at least 1 year after surgery in all patients with respect to both the objective grasp ability and patients' subjective rating of their performance and satisfaction in their prioritized activities. The procedure should therefore be considered as an adjunct to other treatments of upper limb spasticity in spinal cord injury. (C) 2016 by the American Congress of Rehabilitation Medicine
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| 37. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Rehabilitation after spasticity reducing surgery
- 2016
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Ingår i: Reconstructive Surgery and Rehabilitation of the Tetrapelgic Upper Extremity. - Bergen and Gothenburg. - 9788299687171
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 38. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Rehabilitation after triceps reconstruction
- 2016
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Ingår i: Reconstructive Surgery and Rehabilitation of the Tetrapelgic Upper Extremity. - Bergen and Gothenburg. - 9788299687171
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 39. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Reproducibility, Construct Validity, and Responsiveness of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 2
- 2022
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 103:12, s. 2296-2302
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test reliability, construct validity and responsiveness of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a patient-reported outcome measure that assesses perceived performance and satisfaction with 10 standardized activities. Design: Outcome measure psychometric evaluation. Setting: Spinal cord injury units in 2 countries. Participants: Reproducibility: 47 individuals with tetraplegia. Construct validity and responsiveness: 33 individuals with tetraplegia undergoing surgery to restore hand function (N=80). Interventions: Reproducibility: The TUAQ was completed on 2 occasions, 2 weeks apart. Construct validity and responsiveness: Participants completed the TUAQ prior to surgery and 3-12 months after hand reconstruction surgery. Internal consistency was examined using Cronbach alpha. Two agreement parameters were examined: the SEM and minimal detectable change with 90% confidence interval (MDC90). Construct validity was evaluated using Pearson product moment correlation against a priori hypotheses. Responsiveness was assessed using paired t tests and effect size. Results: Test-retest reliability and internal consistency was high (intraclass correlation coefficient of 0.89 for performance scale and 0.88 for satisfaction, Cronbach alpha of 0.92 and 0.90, respectively). For agreement the SEM scores were 4.7 and 3.5, with MDC90 of 10.9 and 8.2, respectively. Responsiveness and construct validity showed sound results with no ceiling or floor effects and with large effect size (>1.05). Conclusions: The TUAQ demonstrates good psychometric properties for reliability and agreement for persons with tetraplegia and responsiveness and construct validity for surgical reconstruction of hand function for persons with tetraplegia. The TUAQ appears appropriate to be used as a patient-reported outcome measure for clinical and research purposes in this population.
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| 40. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia
- 2010
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Ingår i: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:7, s. 563-568
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of grip in tetraplegia aims to improve upper extremity performance and control in daily life. We evaluated the effects of surgery and rehabilitation on performance and satisfaction of patient identified activity goals in 20 patients (22 arms) who had grip reconstructions for both finger and thumb flexion. Patients assessed an improvement in both performance and satisfaction after surgery in all groups of activities assessed using the Canadian Occupational Performance Measure (COPM). The mean improvement at 6 and 12 months was 3.5 points better than the 2.5 points before surgery. Before surgery 36% of the goals identified were impossible to perform. After surgery, 78% of these goals were possible. The largest improvement was observed in the basic activity of 'eating' but significant improvement was also noted in activities generally regarded as complex and not measured in standard ADL such as 'doing housework' and taking part in 'leisure'.
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| 41. |
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