{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:51:55Z","timestamp":1775148715512,"version":"3.50.1"},"reference-count":46,"publisher":"American Spinal Injury Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Approximately 50% of spinal cord injuries (SCI) occur at the cervical level, resulting in significant loss of arm and hand function. Restoration of upper limb function is a high priority, and many opt for upper limb reconstructive surgeries to improve daily activities and psychological well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This retrospective multicenter study investigates whether demographic data (sex and age) and clinical characteristics (type of SCI and years since injury) are related to the outcome of upper limb reconstructive surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data were extracted from medical records of individuals with an SCI who underwent surgery in Sweden and New Zealand. Muscle strength (pinch, grip) and grasp ability were measured before surgery and at 6 or 12 months after surgery using standard methods. Statistical analyses included univariable and multivariable linear regression to assess the association between outcomes and predictors. Outcomes were available for 183 arms at follow-up, assessed through at least one of the response variables: grip strength, pinch strength, or grasp ability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The analyses demonstrated that by using regression models, we could explain 24% to 31% of the variation in pinch strength, grip strength, and grasp ability. The variables of sex, age, and level and severity of injury did explain a small but statistically significant proportion of the variance in pinch strength, grip strength, and grasp ability. Years after injury had no influence on the variation in outcome scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The findings suggest that demographic and injury-related factors partially explain the variation in functional outcomes after surgery, providing valuable insights for clinical decision-making and managing patient expectations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.46292\/sci24-00084","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T08:33:01Z","timestamp":1764923581000},"page":"1-11","source":"Crossref","is-referenced-by-count":0,"title":["Factors That Influence the Clinical Outcome After Tendon Transfer Surgery to Restore Grip Function in Individuals With Tetraplegia"],"prefix":"10.46292","volume":"32","author":[{"given":"Therese","family":"Ramstr\u00f6m","sequence":"first","affiliation":[{"name":"Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital\/M\u00f6lndal, M\u00f6lndal, Sweden"},{"name":"Institute of Clinical Sciences, Department of Hand Surgery at Sahlgrenska Academy, University of Gothenburg, M\u00f6lndal, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Wangdell","sequence":"additional","affiliation":[{"name":"Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital\/M\u00f6lndal, M\u00f6lndal, Sweden"},{"name":"Institute of Clinical Sciences, Department of Hand Surgery at Sahlgrenska Academy, University of Gothenburg, M\u00f6lndal, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"Reinholdt","sequence":"additional","affiliation":[{"name":"Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital\/M\u00f6lndal, M\u00f6lndal, Sweden"},{"name":"Institute of Clinical Sciences, Department of Hand Surgery at Sahlgrenska Academy, University of Gothenburg, M\u00f6lndal, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina Bunketorp","family":"K\u00e4ll","sequence":"additional","affiliation":[{"name":"Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital\/M\u00f6lndal, M\u00f6lndal, Sweden"},{"name":"Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"25425","reference":[{"issue":"9","key":"b1","series-title":"Spine J","first-page":"19942001","article-title":"Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU","volume":"15","author":"Stephan K","year":"2015","unstructured":"Stephan K, Huber S, H\u00e4berle S, et al. Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. Spine J. 2015;15(9):19942001. doi:10.1016\/j.spinee.2015.04.041."},{"issue":"10","key":"b2","series-title":"J Neurotrauma","first-page":"13711383","article-title":"Targeting recovery: Priorities of the spinal cordinjured population","volume":"21","author":"Anderson KD","year":"2004","unstructured":"Anderson KD. Targeting recovery: Priorities of the spinal cordinjured population. J Neurotrauma. 2004;21(10):13711383. doi:10.1089\/neu.2004.21.1371."},{"issue":"9","key":"b3","series-title":"Spinal Cord","first-page":"526532","article-title":"Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics","volume":"42","author":"Snoek GJ","year":"2004","unstructured":"Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, BieringSorensen F. Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 2004;42(9):526532. doi:10.1038\/sj.sc.3101638."},{"issue":"2","key":"b4","series-title":"Top Spinal Cord Inj Rehabil","first-page":"9097","article-title":"Life impacts following reconstructive hand surgery for tetraplegia","volume":"15","author":"Sinnott A","year":"2009","unstructured":"Sinnott A, Brander P, Siegert R, Rothwell A, De Jong G. Life impacts following reconstructive hand surgery for tetraplegia. Top Spinal Cord Inj Rehabil. 2009;15(2):9097. doi:10.1310\/sci150290."},{"issue":"7","key":"b5","series-title":"J Hand Surg Eur","first-page":"563568","article-title":"Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia","volume":"35","author":"Wangdell J","year":"2010","unstructured":"Wangdell J, Friden J. Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia. J Hand Surg Eur. 2010;35(7):563568. doi:10.1177\/1753193410373184."},{"issue":"6","key":"b6","series-title":"J Hand Surg Am","first-page":"11371144","article-title":"Outcomes of singlestage griprelease reconstruction in tetraplegia","volume":"38","author":"Reinholdt C","year":"2013","unstructured":"Reinholdt C, Frid\u00e9n J. Outcomes of singlestage griprelease reconstruction in tetraplegia. J Hand Surg Am. 2013;38(6):11371144. doi:10.1016\/j.jhsa.2013.02.041."},{"issue":"5","key":"b7","series-title":"Spinal Cord","first-page":"266274","article-title":"International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association","volume":"35","author":"Maynard FM Jr","year":"1997","unstructured":"Maynard FM Jr, Bracken MB, Creasey G, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266274. doi:10.1038\/sj.sc.3100432."},{"key":"b8","series-title":"J Hand Surg Am","first-page":"604607","article-title":"The second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia)","volume":"11A","author":"McDowell C","year":"1986","unstructured":"McDowell C, Moberg E, House J. The second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia). J Hand Surg Am. 1986;11A:604607."},{"issue":"7","key":"b9","series-title":"J Hand Surg Eur.","first-page":"965971","article-title":"Expected outcome for reconstructive hand surgery after spinal cord injuries related to level of injury and sex","volume":"50","author":"Ramstr\u00f6m T","year":"2025","unstructured":"Ramstr\u00f6m T, Bunketorp K\u00e4ll L, Dunn J, Reinholdt C, Wangdell J. Expected outcome for reconstructive hand surgery after spinal cord injuries related to level of injury and sex. J Hand Surg Eur. 2025;50(7):965971. doi:10.1177\/17531934241281173."},{"key":"b10","series-title":"Arch Phys Med Rehabil","first-page":"7580","article-title":"Tendon Transfer surgery for people with tetraplegia: An overview","volume":"97","author":"Dunn JA","year":"2016","unstructured":"Dunn JA, Sinnott KA, Rothwell AG, Mohammed KD, Simcock JW. Tendon Transfer surgery for people with tetraplegia: An overview. Arch Phys Med Rehabil. 2016;97(6 Suppl):7580. doi:10.1016\/j.apmr.2016.01.034."},{"issue":"4","key":"b11","series-title":"Tech Hand Up Extrem Surg","first-page":"230235","article-title":"A singlestage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: The alphabet procedure","volume":"15","author":"Frid\u00e9n J","year":"2011","unstructured":"Frid\u00e9n J, Reinholdt C, Turcs\u00e1nyii I, Gohritz A. A singlestage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: The alphabet procedure. Tech Hand Up Extrem Surg. 2011;15(4):230235. doi:10.1097\/BTH.0b013e31821b5896."},{"issue":"12","key":"b12","series-title":"PLoS One","first-page":"113637","article-title":"Grip strength across the life course: Normative data from twelve British studies","volume":"9","author":"Dodds RM","year":"2014","unstructured":"Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: Normative data from twelve British studies. PLoS One. 2014;9(12):113637. doi:10.1371\/journal.pone.0113637."},{"issue":"1","key":"b13","series-title":"J Hand Surg Eur","first-page":"7684","article-title":"Age and genderspecific normative data of grip and pinch strength in a healthy adult Swiss population","volume":"34","author":"Werle S","year":"2009","unstructured":"Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age and genderspecific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur. 2009;34(1):7684. doi:10.1177\/1753193408096763."},{"issue":"2","key":"b14","series-title":"J Hand Surg Am","first-page":"209218","article-title":"Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis","volume":"19","author":"Wuolle KS","year":"1994","unstructured":"Wuolle KS, Van Doren CL, Thrope GB, Keith MW, Peckham PH. Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis. J Hand Surg Am. 1994;19(2):209218. doi:10.1016\/03635023(94)900086."},{"key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"169181","article-title":"Measurement of outcomes of upper limb reconstructive surgery for tetraplegia","volume":"97","author":"Sinnott KA","year":"2016","unstructured":"Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of outcomes of upper limb reconstructive surgery for tetraplegia. Arch Phys Med Rehabil. 2016;97(6 Suppl):169181. doi:10.1016\/j.apmr.2015.10.110."},{"issue":"8","key":"b16","series-title":"Spinal Cord","first-page":"466468","article-title":"Grasp and Release Test for tetraplegic hand assessment: An update of the Grasp and Release Test","volume":"61","author":"Dunn JA","year":"2023","unstructured":"Dunn JA, Wangdell J, Bryden A. Grasp and Release Test for tetraplegic hand assessment: An update of the Grasp and Release Test. Spinal Cord. 2023;61(8):466468. doi:10.1038\/s41393023009070."},{"issue":"1","key":"b17","series-title":"J Spinal Cord Med","first-page":"4146","article-title":"Psychometric rigor of the Grasp and Release Test for measuring functional limitation of persons with tetraplegia: A preliminary analysis","volume":"27","author":"Mulcahey MJ","year":"2004","unstructured":"Mulcahey MJ, Smith BT, Betz RR. Psychometric rigor of the Grasp and Release Test for measuring functional limitation of persons with tetraplegia: A preliminary analysis. J Spinal Cord Med. 2004;27(1):4146."},{"issue":"1","key":"b18","series-title":"J Stat Softw","first-page":"127","article-title":"Relative importance for linear regression in R: The package relaimpo","volume":"17","author":"Groemping U","year":"2006","unstructured":"Groemping U. Relative importance for linear regression in R: The package relaimpo. J Stat Softw. 2006;17(1):127. doi:10.18637\/jss.v017.i01."},{"issue":"2","key":"b19","series-title":"Am Stat","first-page":"139147","article-title":"Estimators of relative importance in linear regression based on variance decomposition","volume":"61","author":"Gr\u00f6mping U","year":"2007","unstructured":"Gr\u00f6mping U. Estimators of relative importance in linear regression based on variance decomposition. 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Int J Rehabil Res. 2010;33(1):411. doi:10.1097\/MRR.0b013e328325a8ba."},{"issue":"6","key":"b22","series-title":"J Spinal Cord Med","first-page":"693702","article-title":"Effects of spinal cord injury on body composition and metabolic profile part I","volume":"37","author":"Gorgey AS","year":"2014","unstructured":"Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile part I. J Spinal Cord Med. 2014;37(6):693702. doi:10.1179\/2045772314y.0000000245."},{"issue":"11","key":"b23","series-title":"Spinal Cord","first-page":"844847","article-title":"Issues influencing the decision to have upper limb surgery for people with tetraplegia","volume":"50","author":"Dunn JA","year":"2012","unstructured":"Dunn JA, HaySmith EJ, Whitehead LC, Keeling S. Issues influencing the decision to have upper limb surgery for people with tetraplegia. Spinal Cord. 2012;50(11):844847. doi:10.1038\/sc.2012.58."},{"issue":"9","key":"b1","series-title":"Spine J","first-page":"19942001","article-title":"Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU","volume":"15","author":"Stephan K","year":"2015","unstructured":"Stephan K, Huber S, H\u00e4berle S, et al. Spinal cord injury-incidence, prognosis, and outcome: an analysis of the TraumaRegister DGU. Spine J. 2015;15(9):19942001. doi:10.1016\/j.spinee.2015.04.041."},{"issue":"10","key":"b2","series-title":"J Neurotrauma","first-page":"13711383","article-title":"Targeting recovery: Priorities of the spinal cordinjured population","volume":"21","author":"Anderson KD","year":"2004","unstructured":"Anderson KD. Targeting recovery: Priorities of the spinal cordinjured population. J Neurotrauma. 2004;21(10):13711383. doi:10.1089\/neu.2004.21.1371."},{"issue":"9","key":"b3","series-title":"Spinal Cord","first-page":"526532","article-title":"Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics","volume":"42","author":"Snoek GJ","year":"2004","unstructured":"Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, BieringSorensen F. Survey of the needs of patients with spinal cord injury: Impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 2004;42(9):526532. doi:10.1038\/sj.sc.3101638."},{"issue":"2","key":"b4","series-title":"Top Spinal Cord Inj Rehabil","first-page":"9097","article-title":"Life impacts following reconstructive hand surgery for tetraplegia","volume":"15","author":"Sinnott A","year":"2009","unstructured":"Sinnott A, Brander P, Siegert R, Rothwell A, De Jong G. Life impacts following reconstructive hand surgery for tetraplegia. Top Spinal Cord Inj Rehabil. 2009;15(2):9097. doi:10.1310\/sci150290."},{"issue":"7","key":"b5","series-title":"J Hand Surg Eur","first-page":"563568","article-title":"Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia","volume":"35","author":"Wangdell J","year":"2010","unstructured":"Wangdell J, Friden J. Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia. J Hand Surg Eur. 2010;35(7):563568. doi:10.1177\/1753193410373184."},{"issue":"6","key":"b6","series-title":"J Hand Surg Am","first-page":"11371144","article-title":"Outcomes of singlestage griprelease reconstruction in tetraplegia","volume":"38","author":"Reinholdt C","year":"2013","unstructured":"Reinholdt C, Frid\u00e9n J. Outcomes of singlestage griprelease reconstruction in tetraplegia. J Hand Surg Am. 2013;38(6):11371144. doi:10.1016\/j.jhsa.2013.02.041."},{"issue":"5","key":"b7","series-title":"Spinal Cord","first-page":"266274","article-title":"International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association","volume":"35","author":"Maynard FM Jr","year":"1997","unstructured":"Maynard FM Jr, Bracken MB, Creasey G, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266274. doi:10.1038\/sj.sc.3100432."},{"key":"b8","series-title":"J Hand Surg Am","first-page":"604607","article-title":"The second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia)","volume":"11A","author":"McDowell C","year":"1986","unstructured":"McDowell C, Moberg E, House J. The second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia). J Hand Surg Am. 1986;11A:604607."},{"issue":"7","key":"b9","series-title":"J Hand Surg Eur.","first-page":"965971","article-title":"Expected outcome for reconstructive hand surgery after spinal cord injuries related to level of injury and sex","volume":"50","author":"Ramstr\u00f6m T","year":"2025","unstructured":"Ramstr\u00f6m T, Bunketorp K\u00e4ll L, Dunn J, Reinholdt C, Wangdell J. Expected outcome for reconstructive hand surgery after spinal cord injuries related to level of injury and sex. J Hand Surg Eur. 2025;50(7):965971. doi:10.1177\/17531934241281173."},{"key":"b10","series-title":"Arch Phys Med Rehabil","first-page":"7580","article-title":"Tendon Transfer surgery for people with tetraplegia: An overview","volume":"97","author":"Dunn JA","year":"2016","unstructured":"Dunn JA, Sinnott KA, Rothwell AG, Mohammed KD, Simcock JW. Tendon Transfer surgery for people with tetraplegia: An overview. Arch Phys Med Rehabil. 2016;97(6 Suppl):7580. doi:10.1016\/j.apmr.2016.01.034."},{"issue":"4","key":"b11","series-title":"Tech Hand Up Extrem Surg","first-page":"230235","article-title":"A singlestage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: The alphabet procedure","volume":"15","author":"Frid\u00e9n J","year":"2011","unstructured":"Frid\u00e9n J, Reinholdt C, Turcs\u00e1nyii I, Gohritz A. A singlestage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: The alphabet procedure. Tech Hand Up Extrem Surg. 2011;15(4):230235. doi:10.1097\/BTH.0b013e31821b5896."},{"issue":"12","key":"b12","series-title":"PLoS One","first-page":"113637","article-title":"Grip strength across the life course: Normative data from twelve British studies","volume":"9","author":"Dodds RM","year":"2014","unstructured":"Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: Normative data from twelve British studies. PLoS One. 2014;9(12):113637. doi:10.1371\/journal.pone.0113637."},{"issue":"1","key":"b13","series-title":"J Hand Surg Eur","first-page":"7684","article-title":"Age and genderspecific normative data of grip and pinch strength in a healthy adult Swiss population","volume":"34","author":"Werle S","year":"2009","unstructured":"Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age and genderspecific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur. 2009;34(1):7684. doi:10.1177\/1753193408096763."},{"issue":"2","key":"b14","series-title":"J Hand Surg Am","first-page":"209218","article-title":"Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis","volume":"19","author":"Wuolle KS","year":"1994","unstructured":"Wuolle KS, Van Doren CL, Thrope GB, Keith MW, Peckham PH. Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis. J Hand Surg Am. 1994;19(2):209218. doi:10.1016\/03635023(94)900086."},{"key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"169181","article-title":"Measurement of outcomes of upper limb reconstructive surgery for tetraplegia","volume":"97","author":"Sinnott KA","year":"2016","unstructured":"Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of outcomes of upper limb reconstructive surgery for tetraplegia. 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