Choice-Based Evaluation for the Improvement of Upper-Extremity Function Compared With Other Impairments in Tetraplegia

Objectives: To assess preference of reconstructive treatment of upper extremities in subjects with tetraplegia compared with preference of treatment of 3 other impairments and to determine the effect of subjects’ characteristics on preference of upper-extremity reconstruction. Design: Survey. Setting: Two specialized spinal cord injury centers in the Netherlands. Participants: A consecutive sample of 47 patients with tetraplegia in stable condition. Interventions: Not applicable. Main Outcome Measure: The quality weight of 5 tetraplegic health states determined with the time trade-off technique and expressed as a single value (the “utility”) on a scale between 0 (worst possible situation) and 1 (best possible situation). Results: The response rate was 92%. The utility of tetraplegia ± standard deviation was .57±.30. The utilities of tetraplegia without impairment in one of the following functions were .69±.33 for sexuality, .69±.33 for standing/walking, .63±.31 for bladder and bowel function, and .65±.32 for upper-extremity function. The differences between these utilities and the utility of tetraplegia were significant (P<.05). No significant differences were found between the utilities of the impairments. Improvement of a specific impairment contributed between 14% and 28% to the potential overall gain in the tetraplegic health state utility. Conclusions: The combination of impairments determines the low utility of the tetraplegic health state. No priority for improvement of any of the investigated impairments was found. This emphasizes the need for the meticulous selection of patients for treatment of specific conditions. Further research should try to determine the crucial factors in the decision-making process of patients for specific interventions