Background: 

After a radial nerve injury, patients must weigh a complicated set of advantages and disadvantages to observation or surgery. We conducted semistructured interviews to characterize the decision-making process that these patients undertake.

Methods: 

We recruited participants who were treated with expectant management (nonoperatively), received only a tendon transfer, or received a nerve transfer. Participants completed a semistructured interview that was transcribed and coded to identify recurring themes, to describe the influence of qualitative findings on treatment decision-making.

Results: 

We interviewed 15 participants (5 expectant management, 5 tendon transfer only, and 5 nerve transfer). Participants’ primary concerns were returning to work, hand appearance, regaining motion, resuming activities of daily living, and enjoying hobbies. Delayed diagnosis and/or insurance coverage led 3 participants to change treatment from nerve transfer to isolated tendon transfer. Interactions with providers early in diagnosis and treatment had strong effects on how members of the care team were perceived. The hand therapist was the primary person who shaped expectations, provided encouragement, and prompted referral to the treating surgeon. Participants valued debate among the care team members regarding treatment, provided that medical terminology was explained.

Conclusions: 

This study highlights the importance of initial, collaborative care in setting expectations for patients with radial nerve injuries. Many participants named returning to work and hand appearance as primary concerns. Hand therapists were the primary source of support and information during recovery.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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桡神经损伤的期待治疗、肌腱移植或神经移植手术：一项探索患者期望、目标和治疗经验的定性研究

背景： 

桡神经损伤后，患者必须权衡观察或手术的一系列复杂利弊。我们进行了半结构化访谈来描述这些患者进行的决策过程。

方法： 

我们招募了接受期待治疗（非手术）、仅接受肌腱移植或神经移植的参与者。参与者完成了半结构化访谈，该访谈被转录和编码以识别反复出现的主题，以描述定性发现对治疗决策的影响。

结果： 

我们采访了 15 名参与者（5 名期待治疗，5 名仅肌腱转移，5 名神经转移）。参与者最关心的是重返工作岗位、手部外观、恢复运动、恢复日常生活活动和享受爱好。延迟诊断和/或保险范围导致 3 名参与者将治疗从神经转移改为孤立的肌腱转移。在诊断和治疗的早期与提供者的互动对护理团队成员的看法有很大影响。手部治疗师是塑造期望、提供鼓励并促使转介给治疗外科医生的主要人员。参与者重视护理团队成员之间关于治疗的辩论，前提是医学术语得到解释。

结论： 

这项研究强调了初始协作护理在为桡神经损伤患者设定期望方面的重要性。许多参与者将重返工作岗位和手部外观列为主要关注点。手部治疗师是康复期间支持和信息的主要来源。

证据等级： 

治疗等级IV。有关证据等级的完整描述，请参阅作者须知。