Perceived activity performance is not readily correlated with functional factors in reconstructive tetraplegia hand surgery

Johanna Wangdell, occupational therapist at the National Center of Reconstructive Tetraplegia Hand Surgery, Sweden reports the results of a study among 48 persons (33 men and 15 women) with tetraplegia who underwent tendon transfer surgery in the hand between 2002 and 2008. In order to collect the patients’ activity goals and their performance of these activities, the Canadian Occupational Performance Measurement (COPM) was used. Difference between preop and 1 year postop COPM scores indicated activity change. The expressed activity goals were spread over a wide range of activities. Average activity improvement for each person was 3.3 scale steps (-0.7 - 7). Grip and pinch strength at 1 year was 7.5 and 2.1 kg, respectively. Distance between thumb and index finger was 5.5 cm (0-15). There were no strong or significant correlations between patients’ perceived performance with their activity goals and any of the functional outcomes. There are important improvements in both physical and activity perspective but the correlations between those dimensions are non-existing or low. The lack of correlation could be explained by the fact that individuals living with tetraplegia still, even after a grip reconstruction, have to perform many of their activities in an adjusted way, especially if the injury is high. Johanna Wangdell concludes that if the surgery is done in non-dominant hand or a hand without sensibility the relearning process is even more challenging.