Preference for reconstructive interventions of the upper extremities in tetraplegia: The impact of treatment characteristics

Different surgical procedures are described to improve handfunction in tetraplegie either with or without implantation of an 8-channel electrical stimulator. Clinical experience shows that patients are not always willing to accept these devices despite their severe functional limitations. This can be explained because the offered treatment is too demanding. For future clinical applications and for further technical developments it is necessary to obtain more insight into the factors that determine willingness to accept assistive technology. OBJECTIVES: To determine the effect of treatment characteristics of upper extremity interventions on the decision of tetraplegic subjects to accept treatment. METHOD: A discrete choice experiment (DCE) was performed, where treatment characteristics were obtained to establish different treatment scenarios. Seven different treatment characteristics were obtained from a panel of international experts. Tetraplegics were offered 20 sets of two different treatment scenarios and asked to select the best scenario. RESULTS: A total of 47 tetraplegic subjects with C5–6 lesions, motor group M1–4 were selected. Relative importance of treatment characteristics were: intervention type (surgery or surgery with FES implant) 13%, number of operations 15%, in patient rehabilitation period 22%, ambulant rehabilitation period 9%, complication rate 15%, improvement of elbow function 10%, improvement of hand function 15%. Effects of various changes of treatment protocols were determined. An inpatient rehabilitation period of maximum 4 weeks increases preference for treatment with 32%. One instead of two operative procedures increases the preference with 25%. CONCLUSION: In-patient rehabilitation period appears to have the greatest impact on the decision by patients to have surgery or not. Implantation of a neural implant is not the main reason for not accepting this type of treatment