Dataset Information

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury.

ABSTRACT:

Purpose

Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons' perspectives on the care of BPI patients and potential areas for improvement in care delivery.

Methods

We conducted semistructured qualitative interviews with 14 surgeons with expertise in BPI reconstruction. The interview guide contained questions regarding the surgeons' practice and care team structure, their attitudes and approaches to psychological and emotional aspects of recovery, and their preferences for setting patient expectations. We used inductive thematic analysis to identify themes.

Results

There was a high degree of variability in how surgeons addressed emotional and psychological aspects of recovery. Whereas some surgeons embraced the practice of addressing these components of care, others felt strongly that BPI surgeons should remain focused on technical aspects of care. Several participants described the emotional toll that caring for BPI patients can have on surgeons and how this concern has affected their approach to care. Surgeons also recognized the importance of setting preoperative expectations. There was an emphasis on setting low expectations in an attempt to minimize the risk for dissatisfaction. Surgeons described the challenges in effectively counseling patients about a condition that is prone to substantial injury heterogeneity and variability in functional outcomes.

Conclusions

Our results demonstrate wide variability in how surgeons address emotional, psychological, and social barriers to recovery for BPI patients.

Clinical relevance

Best practices for BPI care are difficult to establish because of the relative heterogeneity of neurologic injury, the unpredictable impact and recovery of the patient, and the substantial variability in physician approach to the care of these patients.

SUBMITTER: Dy CJ

PROVIDER: S-EPMC7853659 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury.

Dy Christopher J CJ Brogan David M DM Rolf Liz L Ray Wilson Z WZ Wolfe Scott W SW James Aimee S AS

Journal of hand surgery global online 20201121 1

<h4>Purpose</h4>Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons' perspectives on the care of BPI patients and potential areas for improvement in care delivery.<h4>Methods</h4 ...[more]

PMID: 33537663

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Project description:BackgroundTraumatic brachial plexus injuries (BPIs) disproportionately affect young, able-bodied individuals. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI.MethodsWe estimated indirect costs as the sum of (1) short-term wage loss, (2) long-term wage loss, and (3) disability payments. Short-term (6-month) wage loss was the product of missed work days and the average earnings per day. The probability of return to work was derived from a systematic review of the literature, and long-term wage loss and disability payments were estimated. Monte Carlo simulation was used to perform a sensitivity analysis of long-term wage loss by varying age, sex, and return to work simultaneously. Disability benefits were estimated from U.S. Social Security Administration data. All cost estimates are in 2018 U.S. dollars.ResultsA systematic review of the literature demonstrated that the patients with BPI had a mean age of 26.4 years, 90.5% were male, and manual labor was the most represented occupation. On the basis on these demographics, our base case was a 26-year-old American man working as a manual laborer prior to BPI, with an annual wage of $36,590. Monte Carlo simulation estimated a short-term wage loss of $22,740, a long-term wage loss of $737,551, and disability benefits of $353,671. The mean total indirect cost of traumatic BPI in the Monte Carlo simulations was $1,113,962 per patient over the post-injury lifetime (median: $801,723, interquartile range: $22,740 to $2,350,979). If the probability of the patient returning to work at a different, lower-paying job was doubled, the per-patient total indirect cost was $867,987.ConclusionsBPI can have a far-reaching economic impact on both individuals and society. If surgical reconstruction enables patients with a BPI to return to work, the indirect cost of this injury decreases.Level of evidenceEconomic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Project description:Background and purposeBrachial plexus birth injury is caused by traction on the neck during delivery and results in flaccid palsy of an upper extremity commonly involving C5-C6 nerve roots. MR imaging and MR myelography help to assess the anatomic location, extent, and severity of brachial plexus injuries which influence the long-term prognosis along with the surgical decision making. Recently, sonography has been increasingly used as the imaging modality of choice for brachial plexus injuries. The aim of this study was to assess the degree of correlation among brachial plexus sonography, MR imaging, and surgical findings in children with brachial plexus birth injury.Materials and methodsThis prospective study included 55 consecutive patients (girls/boys = 32:23; mean age, 2.1 ± 0.8 months) with brachial plexus birth injury between May 2014 and April 2017. The patients were classified according to the Narakas classification and were followed up at 4- to 6-week intervals for recovery by the Modified Mallet system and sonography without specific preparation for evaluation. All patients had MR imaging under general anesthesia. Nerve root avulsion-retraction, pseudomeningocele, and periscalene soft tissue were accepted brachial plexus injury findings on imaging. Interobserver agreement for MR imaging and the agreement between imaging and surgical findings were estimated using the κ statistic. The diagnostic accuracy of sonography and MR imaging was calculated on the basis of the standard reference, which was the surgical findings.ResultsForty-three patients had pre- and postganglionic injury, 12 had only postganglionic injury findings, and 47% of patients underwent an operation. On sonography, no patients had preganglionic injury, but all patients had postganglionic injury findings. For postganglionic injury, the concordance rates between imaging and the surgical findings ranged from 84% to 100%, and the diagnostic accuracy of sonography and MR imaging was 89% and 100%, respectively. For preganglionic injury, the diagnostic accuracy of MR imaging was 92%. Interobserver agreement and the agreement between imaging and the surgical findings were almost perfect for postganglionic injury (κ = 0.81-1, P < .001).ConclusionsHigh-resolution sonography can identify and locate the postganglionic injury associated with the upper and middle trunks. The ability of sonography to evaluate pre- and the postganglionic injury associated with the lower trunk was quite limited. Sonography can be used as a complement to MR imaging; thus, the duration of the MR imaging examination and the need for sedation can be reduced by sonography.

Project description:IntroductionTraumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care.Methods and analysisThis mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS.Ethics and disseminationThe use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval.Trial registration numbersCRD42018109843.

Dataset Information

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury.

Purpose

Methods

Results

Conclusions

Clinical relevance

Publications

Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury.

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