{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T22:07:49Z","timestamp":1770329269324,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Upper Limb Surgery Endowment Fund, Burwood Hospital Christchurch New Zealand"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Cervical spinal cord injury (SCI) causing tetraplegia is extremely disabling. In such circumstances, restoration of upper extremity (UE) function is considered the highest priority. The advent of early nerve transfer (NT) procedures, in addition to more traditional tendon transfers (TT), warranted in-depth consideration given the time-limited nature of NT procedures. Potential surgery candidates may not yet have come to terms with the permanence of their disability. A mixed methods convergent design was utilized for concurrent analysis of the Aotearoa\/New Zealand upper limb registry data from the clinical assessments of all individuals considering UE surgery, regardless of their final decision. The International Classification of Functioning, Disability and Health (ICF) taxonomy guided data interpretation during the three-phased study series. It was the integration of the findings using the Stewart Model of care drawn from palliative health that enabled the interpretation of higher order messages. It is clear the clinical assessment and selection processes in use require reconsideration given the complexities individuals face following onset of SCI. We draw attention to the higher order cognitive demands placed on individuals, the requirement for SCI peer involvement in decision making and the need for acknowledgment of interdependence as a relational construct when living with tetraplegia.<\/jats:p>","DOI":"10.3390\/jpm13030394","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T02:03:26Z","timestamp":1677204206000},"page":"394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Mixed Methods Approach as a Channel to Interpret Outcomes Research and Lived Experience Enquiry of Upper Extremity Elective Surgery for Tetraplegia"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8544-8629","authenticated-orcid":false,"given":"K. Anne","family":"Sinnott Jerram","sequence":"first","affiliation":[{"name":"John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Camperdown, NSW 2006, Australia"},{"name":"Burwood Academy Trust, Christchurch 8083, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2894-7533","authenticated-orcid":false,"given":"Jennifer","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Smaill","sequence":"additional","affiliation":[{"name":"Burwood Academy Trust, Christchurch 8083, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Middleton","sequence":"additional","affiliation":[{"name":"John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Camperdown, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bichenbach, J. (2013). International Perspectives on Spinal Cord Injury.","DOI":"10.1310\/sci1901-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1016\/j.jhsa.2015.06.003","article-title":"Tetraplegia Management Update","volume":"40","author":"Gohritz","year":"2015","journal-title":"J. Hand Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.jhsa.2012.01.026","article-title":"Activity Gains after Reconstructions of Elbow Extension in Patients with Tetraplegia","volume":"37","author":"Wangdell","year":"2012","journal-title":"J. Hand Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.3109\/09638288.2013.768709","article-title":"Enhanced independence: Experiences after regaining grip function in people with tetraplegia","volume":"35","author":"Wangdell","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"678","DOI":"10.3109\/09638288.2013.808276","article-title":"From regained function to daily use: Experiences of surgical reconstruction of grip in people with tetraplegia","volume":"36","author":"Wangdell","year":"2014","journal-title":"Disabil. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1016\/j.apmr.2016.01.034","article-title":"Tendon Transfer Surgery for People with Tetraplegia: An Overview","volume":"97","author":"Dunn","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1310\/sci1801-43","article-title":"Surgical Restoration of Arm and Hand Function in People with Tetraplegia","volume":"18","author":"Bryden","year":"2012","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1055\/s-0035-1558427","article-title":"Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury","volume":"10","author":"Cain","year":"2015","journal-title":"J. Brachial Plex. Peripher. Nerve Inj."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S0140-6736(19)31332-7","article-title":"Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: A prospective case series","volume":"394","author":"Hill","year":"2019","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/1753193419886443","article-title":"Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia","volume":"45","author":"Ledgard","year":"2020","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/sc.2016.128","article-title":"Identification of patients with cervical SCI suitable for early nerve transfer to achieve hand opening","volume":"55","author":"Simcock","year":"2017","journal-title":"Spinal Cord"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1152\/japplphysiol.00529.2020","article-title":"Upper and lower motor neuron lesions in tetraplegia: Implications for surgical nerve transfer to restore hand function","volume":"129","author":"Bersch","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1016\/j.apmr.2016.03.015","article-title":"Rehabilitation after surgical reconstruction to restore function to the Upper Limb in Tetraplegia: A changing landscape","volume":"97","author":"Johanson","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1108\/IJHRH-08-2018-0054","article-title":"The Burwood Academy: Incorporating the principles of the Independent Living paradigm into rehabilitation research","volume":"12","author":"Bourke","year":"2019","journal-title":"Int. J. Hum. Rights Healthc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"61","DOI":"10.17645\/si.v6i1.1175","article-title":"Rehabilitation as a disability equality issue: A conceptual shift for Disability Studies?","volume":"6","author":"Shakespeare","year":"2018","journal-title":"Soc. Incl."},{"key":"ref_16","unstructured":"Costa, A., and Villalba, E. (2017). Horizons in Neuroscience Research, Nova Science Publishers."},{"key":"ref_17","unstructured":"Craig, A., and Middleton, J.W. (2022). Guide for Health Professionals on the Psychosocial Care of Adults with Spinal Cord Injury AFC Innovation."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1037\/a0035778","article-title":"Injury perceptions, hope for recovery, and psychological status after spinal cord injury","volume":"59","author":"Krause","year":"2014","journal-title":"Rehabil. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/S0277-9536(98)00411-0","article-title":"The disability paradox: High quality of life against all odds","volume":"48","author":"Albrecht","year":"1999","journal-title":"Soc. Sci. Med."},{"key":"ref_20","unstructured":"WHO (2001). International Classification of Functioning, Disability and Health, ICF."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.hcl.2008.01.005","article-title":"Measurement Issues Related to Upper Limb Interventions in Persons Who Have Tetraplegia","volume":"24","author":"Dunn","year":"2008","journal-title":"Hand Clin."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Sinnott Jerram, K.A., Dunn, J.A., Smaill, R.P., and Middleton, J.W. (2019). Using Mixed Methods to Better Appreciate the Life Impact of Upper Limb Reconstruction Surgeries for Tetraplegia in New Zealand, JSM Orthopedics and Rheumatology.","DOI":"10.15761\/PMRR.1000194"},{"key":"ref_23","first-page":"48","article-title":"Clinical Utility of Patient Reported Outcome Measures Used for Tendon and Nerve Transfers for Tetraplegia in New Zealand","volume":"5","author":"Dunn","year":"2022","journal-title":"J. Hand Surg. Glob."},{"key":"ref_24","unstructured":"Sinnott Jerram, K.A., Dunn, J.A., Smaill, R.P., and Middleton, J.W. (J. Patient Exp., 2023). ICF Word Mapping to Determine the Human Functioning associated with upper extremity surgery for tetraplegia, J. Patient Exp., under review."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1177\/000841749005700207","article-title":"The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy","volume":"57","author":"Law","year":"1990","journal-title":"Can. J. Occup. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1016\/S0003-9993(98)90412-9","article-title":"The capabilities of upper extremity instrument: Reliability and validity of a measure of functional limitation in tetraplegia","volume":"79","author":"Marino","year":"1998","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","unstructured":"Cummins, R. (2010). Personal Wellbeing Index. Australian Centre on Quality of Life, Deakin University."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/0363-5023(94)90008-6","article-title":"Development of a quantitative hand Grasp and Release Test for patients with tetraplegia using a hand neuroprosthesis","volume":"19","author":"Wuolle","year":"1994","journal-title":"J. Hand Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1080\/16501970510040263","article-title":"ICF linking rules: An update based on lessons learned","volume":"37","author":"Cieza","year":"2005","journal-title":"J. Rehabil. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_31","first-page":"1","article-title":"One size fits all? What counts as quality practice in (reflexive) thematic analysis?","volume":"318","author":"Braun","year":"2020","journal-title":"Qual. Res. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3102\/01623737011003255","article-title":"Toward a conceptual framework for mixed method evaluation designs","volume":"11","author":"Greene","year":"1989","journal-title":"Educ. Eval. Policy Anal."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/j.1468-0009.2005.00397.x","article-title":"Evaluating the quality of medical care. 1966","volume":"83","author":"Donabedian","year":"2005","journal-title":"Milbank Q."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/hex.12640","article-title":"How to practice person-centred care: A conceptual framework","volume":"21","author":"Santana","year":"2017","journal-title":"Health Expect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0885-3924(98)00131-6","article-title":"The Concept of Quality of Life of Dying Persons in the Context of Health Care","volume":"17","author":"Stewart","year":"1999","journal-title":"J. Pain Symptom Manag."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.3109\/09638288.2010.523104","article-title":"The Personal Factors of the International Classification of Functioning, Disability and Health in the literature\u2014A systematic review and content analysis","volume":"33","author":"Geyh","year":"2011","journal-title":"Disabil. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1080\/09638288.2018.1445302","article-title":"Representing and organizing information to describe the lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health (ICF): A discussion paper","volume":"41","author":"Geyh","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_38","first-page":"400","article-title":"Goal setting and strategies to enhance goal pursuit in adult rehabilitation: Summary of a Cochrane systematic review and meta-analysis","volume":"52","author":"Levack","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Tractenberg, R., Garver, A., Ljungberg, I., Schladen, M., and Groah, S. (2017). Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171114"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sandalic, D., Craig, A., Tran, Y., Arora, M., Pozzato, I., McBain, C., Tonkin, H., Simpson, G., Gopinath, B., and Kaur, J. (2022). Cognitive Impairment in Individuals with Spinal Cord Injury: Findings of a Systematic Review with Robust Variance and Network Meta-analyses. Neurology, 10\u201319.","DOI":"10.1212\/WNL.0000000000200957"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1016\/j.apmr.2015.09.026","article-title":"Decision-Making about Upper Limb Tendon Transfer Surgery by People with Tetraplegia for More than 10 Years","volume":"97","author":"Dunn","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jhsa.2004.08.014","article-title":"Physician perceptions of upper extremity reconstruction for the person with tetraplegia","volume":"30","author":"Curtin","year":"2005","journal-title":"J. Hand Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jhsa.2004.10.007","article-title":"Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study","volume":"30","author":"Curtin","year":"2005","journal-title":"J. Hand Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.hcl.2008.01.001","article-title":"Current Utilization of Reconstructive Upper Limb Surgery in Tetraplegia","volume":"24","author":"Squitieri","year":"2008","journal-title":"Hand Clin."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1038\/sc.2010.15","article-title":"Upper limb reconstructive surgery uptake for persons with tetraplegia in New Zealand: A retrospective case review 2001\u20132005","volume":"48","author":"Dunn","year":"2010","journal-title":"Spinal Cord"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/3\/394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:40:38Z","timestamp":1760121638000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/3\/394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["jpm13030394"],"URL":"https:\/\/doi.org\/10.3390\/jpm13030394","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}