Enhanced independence: experiences after regaining grip function in people with tetraplegia.

PURPOSE: To explore how surgical reconstruction of grip affects everyday life for patients with tetraplegia, with special emphasis on patients perspective of their perceived changes. DESIGN: Qualitative method. SUBJECTS: Eleven people (aged 22-73) with tetraplegia who had undergone surgical reconstruction to restore grip function. METHODS: Qualitative interviews were conducted 7-17 months after surgery and analysed using Grounded theory. RESULTS: The core concept describing the participants experienced gains after grip reconstructive surgery was "enhanced independence". It was associated with changes in both practical and psychological aspects of independence. Practical aspects identified were: "perform more activities", "smoother everyday life", "renewed ability to participate in social activities", "less dependence on assistance" and "less restricted by physical environment". Psychological aspects of independence included "regained privacy", "increased manageability", "regained identity", "recapture a part of the body" and "share positive experiences with relatives and friends". Encompassing all categories was the concept "self-efficacy in hand control". It was seen as a result included in the enhanced independency core but also as an important factor for the development of all the other categories. CONCLUSION: Participants in this study experienced enhanced independence after grip reconstructive surgery and rehabilitation. The enhanced independence included both practical and physical aspects and it influenced all domains using the International Classification of Function, Disability and Health model; body function and structure, activities, participation, personal factors and environmental factors. Implications for Rehabilitation Patients with tetraplegia experience grip reconstruction as a useful intervention, an enhanced independence, related to their improved hand control. The increased hand control impacted not only physical aspects but also practical and psychological aspects. It also influenced social and community participation and the interference the environment had on the person. Self-efficacy was both a result of the intervention and a catalyst allowing the subcategories to develop. Therefore, self-efficacy in hand control seems to be an important factor to focus on during the rehabilitation process.