Issues influencing the decision to have upper limb surgery for people with tetraplegia

Study design: Grounded theory. Objectives: To explore to better understand the decision-making process of people with tetraplegia regarding reconstructive upper limb (UL) surgery. Setting: New Zealand. Methods: In-depth interviews with 22 people with tetraplegia, 10 of whom had UL surgery and 12 had not. Verbatim transcripts were analysed using constructivist grounded theory. Results: The primary reason for having reconstructive UL surgery was to improve independence and return to previous pastimes. Reasons not to have surgery were hope for further recovery or cure, and inadequate physical environment or social supports while rehabilitating. In addition, women identified the temporary loss of independence and need for increased care while rehabilitating as issues. Importantly, these issues were not static, often changing in importance or relevance over time. Conclusions: The moment of making the decision for reconstructive UL surgery is elusive; therefore, multiple offers of surgery at different timeframes in an individual's life are required. In addition, flexibility in timing for surgery would allow for surgery to better coordinate with an individual's goals and priorities. Spinal Cord (2012) 50, 844-847; doi:10.1038/sc.2012.58; published online 15 May 2012