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‘Being a patient the rest of my life’– The influence of patient participation during recovery after brachial plexus injury

  • Christopher J. Dy
    Correspondence
    Corresponding author. Department of Orthopaedic surgery, Department of Surgery, (Division of Public Health Sciences), 660 S. Euclid, Campus Box 8233, Washington University School of Medicine, St. Louis, MO 63110, Tel.: 314-747-2535.
    Affiliations
    Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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  • David M. Brogan
    Affiliations
    Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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  • Liz Rolf
    Affiliations
    Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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  • Aimee S. James
    Affiliations
    Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Published:November 21, 2021DOI:https://doi.org/10.1016/j.jht.2021.10.002

      Highlights

      • Brachial plexus injury (BPI) patients express variable degrees of participation during their recovery.
      • Uncertainty is frustrating to BPI patients.
      • Many BPI patients feel left out of the decision-making process.

      ABSTRACT

      Background

      Given the modest functional outcomes seen after surgical reconstruction and subsequent therapy, increasing attention is being directed to patient satisfaction and psychological aspects of recovery after brachial plexus injury (BPI).

      Purpose

      To better understand the recovery course after surgical reconstruction for BPI, we used qualitative interviews and focused on common points of frustration for patients.

      Study Design

      Qualitative, interpretive description study

      Methods

      We conducted semi-structured interviews with BPI patients who were 6+ months post-surgical reconstruction. The interview focused on the patients’ experience with BPI, focusing on emotional aspects of recovery. Interviews were transcribed and independently coded by 2 researchers. We used inductive and deductive analysis to organize codes into themes. Once thematic saturation was reached, no additional interviews were conducted.

      Results

      We interviewed 15 BPI patients at median 13 months after surgery (range: 6-43 months). Our analysis revealed: (1) BPI patients expressed variable degrees of participation during recovery, with the indeterminate state of function making it difficult to adjust to life after BPI. (2) The uncertainty while waiting for improved function is frustrating to BPI patients, with many patients expressing concern for activities and moments they are missing due to injury. (3) While many BPI patients feel left out of decision-making, those who felt engaged in the process expressed less frustration and more acceptance of their status.

      Conclusion

      Traumatic BPI patients those who felt engaged in decision-making were more receptive to adjustment to their new state of function. When coordinating multidisciplinary care, measures to encourage patients to feel agency over their outcome and to develop self-management skills have the potential to improve patient satisfaction.

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