Healthcare Provider Factors Affecting Access to Nerve Transfer Surgery to Improve Upper Extremity Function in Individuals with Cervical Spinal Cord Injury

Abstract

Objective: Nerve and tendon transfer surgery has restored upper extremity (UE) function in cervical spinal cord injury (SCI) but is not universally accessible to all eligible individuals. The purpose of this exploratory qualitative study was to understand the healthcare provider factors that are associated with access to nerve transfer surgery for people with SCI.

Design: Semi-structured interviews explored healthcare provider knowledge and practices regarding nerve and tendon transfer surgery to improve UE function in cervical SCI. An inductive, iterative, constant comparative process involving descriptive and interpretive data analyses was used to identify themes, guided by the Consolidated Framework for Implementation Research (CFIR).

Results: Interviews were conducted with healthcare providers (n = 10 UE surgeons, n = 10 SCI physiatrists/hospitalists, n = 6 occupational therapists, n = 6 physical therapists). Nine themes were identified as barriers to accessing care: (1) lack of awareness; (2) lack of sufficient knowledge; (3) lack of buy-in as a priority; (4) lack of collaboration; (5) misperceptions; (6) lack of resources; (7) lack of evidence; (8) lack of ownership amongst rehabilitation specialists; and (9) hesitancy.

Conclusion: This study identified barriers limiting equitable access to nerve transfer surgery. These barriers highlight the need for a multi-modal multidisciplinary approach to address individual-, provider- and system-level barriers.

Keywords: access to care; barriers and facilitators’; nerve transfer; qualitative; spinal cord injury; tendon transfer; tetraplegia.