The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study

Brito, Sara; White, Jenni; Thomacos, Nikos; Hill, Bridget

doi:10.1080/09638288.2019.1668970

Cited by 13 publications

(8 citation statements)

References 39 publications

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“…To address these issues, some BPI centers have included social workers as part of the care team, but additional work is needed to determine best practices and minimize variability in care. Brito et al 13 noted One of the things that I always try to remember about these injuries and these patientsdit's the same with replants. It's the only way I'm able to survive replantsdyou just have to remember: you didn't cut the finger off.…”

Section: Discussionmentioning

confidence: 98%

“…In our analysis of interviews with BPI surgeons, there was a variety of approaches to addressing the emotional, psychological, and social barriers aspects of BPI. When viewed in light of the broad emotional and psychological impact of BPI, 1 , 2 , 5 , 8 – 10 , 13 this variability should be addressed in care system design. Although surgeons are perceived as the leader of the BPI care team in the United States, not all surgeons whom we interviewed felt adept or comfortable with addressing or orchestrating nonsurgical aspects of care.…”

Section: Discussionmentioning

confidence: 99%

“…To address these issues, some BPI centers have included social workers as part of the care team, but additional work is needed to determine best practices and minimize variability in care. Brito et al 13 noted that BPI patients in Australia valued continuity of care and coordination of visits in a specialized BPI clinic, providing a framework for care delivery design. Collaboration and integration with other disciplines such as pain management and psychology were previously discussed, 1 , 3 , 15 , 16 but validation and frameworks for these models are needed to propel widespread adoption.…”

Section: Discussionmentioning

confidence: 99%

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

Brogan

Rolf

et al. 2021

Journal of Hand Surgery Global Online

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…To address these issues, some BPI centers have included social workers as part of the care team, but additional work is needed to determine best practices and minimize variability in care. Brito et al 13 noted that BPI patients in Australia valued continuity of care and coordination of visits in a specialized BPI clinic, providing a framework for care delivery design. Collaboration and integration with other disciplines such as pain management and psychology were previously discussed, 1 , 3 , 15 , 16 but validation and frameworks for these models are needed to propel widespread adoption.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Brogan

Rolf

et al. 2021

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

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“…20 Our results are consistent with previous research demonstrating the impact of pain and adjustment following BPI from the patient's perspective. [21][22][23] Participants discussed the need to look beyond biomedical factors and focus more on biopsychosocial factors. 24 Indeed, rehabilitation provided to people with a BPI may benefit from being considered alongside other conditions requiring longterm recovery such as spinal cord and brain injury.…”

Section: Discussionmentioning

confidence: 99%

Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists’ perspectives

Brito

White

Hill

et al. 2022

Journal of Hand Therapy

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“…Communicating this information to patients has educational value and aids in their adjustment to the injury. 22 Furthermore, BPI patient satisfaction relies heavily on whether expectations are met. 23 Pain is a significant burden for patients with BPI.…”

Section: Smentioning

confidence: 99%

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

Hill

Lanier

Rolf

et al. 2021

Hand (New York, N,Y.)

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Background There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons’ rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. Results Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. Conclusions Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.

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The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study

Cited by 13 publications

References 39 publications

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

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

Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists’ perspectives

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

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