Choice-based evaluation for the improvement of upper-extremity function compared with other impairments in tetraplegia.
OBJECTIVE
To assess preference of reconstructive treatment of upper extremities in subjects with tetraplegia compared with preference of treatment of 3 other impairments and to determine the effect of subjects' characteristics on preference of upper-extremity reconstruction.


METHODS
Survey.


METHODS
Two specialized spinal cord injury centers in the Netherlands.


METHODS
A consecutive sample of 47 patients with tetraplegia in stable condition.


METHODS
Not applicable.


METHODS
The quality weight of 5 tetraplegic health states determined with the time trade-off technique and expressed as a single value (the "utility") on a scale between 0 (worst possible situation) and 1 (best possible situation).


RESULTS
The response rate was 92%. The utility of tetraplegia +/- standard deviation was .57+/-.30. The utilities of tetraplegia without impairment in one of the following functions were .69+/-.33 for sexuality, .69+/-.33 for standing/walking, .63+/-.31 for bladder and bowel function, and .65+/-.32 for upper-extremity function. The differences between these utilities and the utility of tetraplegia were significant (P<.05). No significant differences were found between the utilities of the impairments. Improvement of a specific impairment contributed between 14% and 28% to the potential overall gain in the tetraplegic health state utility.


CONCLUSIONS
The combination of impairments determines the low utility of the tetraplegic health state. No priority for improvement of any of the investigated impairments was found. This emphasizes the need for the meticulous selection of patients for treatment of specific conditions. Further research should try to determine the crucial factors in the decision-making process of patients for specific interventions.
Snoek
Govert J
GJ
Spinal Cord Injury Department, Roessingh Rehabilitation Centre, Enschede, the Netherlands; Research and Development Department, Roessingh Rehabilitation Centre, Enschede, the Netherlands.
IJzerman
Maarten J
MJ
Post
Marcel W
MW
Stiggelbout
Anne M
AM
Roach
Mary J
MJ
Zilvold
Gerrit
G
D000328:Adult; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000503:physiopathology* / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D034941:Upper Extremity / Q000503:physiopathology*