Nothing to lose: a phenomenological study of upper limb nerve transfer surgery for individuals with tetraplegia

Purpose: For individuals with tetraplegia, regaining upper limb function forms the highest priority for improving quality of life. Use of nerve transfers to reconstruct upper limb function is increasing, however little is known about individual's decision to have and experience of the surgery and associated rehabilitation outcomes. This qualitative study aimed to understand the experience of surgery on the lives of individuals with tetraplegia 18 months post-surgery. Method: In-depth, semi-structured interviews were conducted with five purposively selected individuals who have undergone upper limb nerve transfers at a metropolitan health service, Melbourne, Australia, specializing in spinal cord injury rehabilitation. Collaizi's phenomenological framework guided data analysis, resulting in an essence statement describing the individuals' experience. Results: An essence statement comprising three themes; Deciding on Surgery, Facing Challenges: Surgery to Recovery and Evaluating Surgical Outcomes, was developed. Conclusion: The study suggests that for individuals with tetraplegia, hope to regain lost upper limb function forms a core consideration in the decision to have surgery. For clinicians supporting patient's decision, balancing hope with the realities of surgery is important. Even small changes in upper limb function had an important influence on participant's confidence in social situations through enhanced participation in a range of everyday activities.