Indiana University School of Medicine, Indianapolis, USA.
Hand (N Y). 2022 Sep;17(5):926-932. doi: 10.1177/1558944720976413. Epub 2020 Dec 15.
Reconstructive surgery for upper extremity manifestations of cerebral palsy (CP) has been demonstrated to be safe and effective, yet many potential candidates are never evaluated for surgery. The purpose of this study was to determine barriers to upper extremity reconstruction for patients with CP in a cohort of upper extremity surgeons and nonsurgeons.
We sent a questionnaire to 4167 surgeons and nonsurgeon physicians, aggregated responses, and analyzed for differences in perceptions regarding surgical efficacy, patient candidacy for surgery, compliance with rehabilitation, remuneration, complexity of care, and physician comfort providing care.
Surgeons and nonsurgeons did not agree on the literature support of surgical efficacy (73% vs 35% agree or strongly agree, respectively). Both surgeons and nonsurgeons felt that many potential candidates exist, yet there was variability in their confidence in identifying them. Most surgeons (59%) and nonsurgeons (61%) felt comfortable performing surgery and directing the associated rehabilitation, respectively. Neither group reported that patient compliance, access to rehabilitation services, and available financial resources were a major barrier, but surgeons were more likely than nonsurgeons to feel that remuneration for services was inadequate (37% vs 13%). Both groups agreed that surgical treatments are complex and should be performed in the setting of a multidisciplinary team.
Surgeons and nonsurgeons differ in their views regarding upper extremity reconstructive surgery for CP. Barriers to reconstruction may be addressed by performing higher level research, implementing multispecialty educational outreach, developing objective referral criteria, increasing surgical remuneration, improving access to trained upper extremity surgeons, and implementing multidisciplinary CP clinics.
脑瘫（CP）上肢表现的重建手术已被证明是安全有效的，但许多潜在的候选者从未接受过手术评估。本研究的目的是在一组上肢外科医生和非外科医生中确定 CP 患者上肢重建的障碍因素。
我们向 4167 名外科医生和非外科医生发放了一份问卷，汇总了回复并进行了分析，以了解他们对手术疗效、手术候选者、康复依从性、薪酬、护理复杂性以及提供护理的医生舒适度的看法存在差异。
外科医生和非外科医生对手术疗效的文献支持意见不一（分别有 73%和 35%表示同意或强烈同意）。外科医生和非外科医生都认为有许多潜在的候选者，但他们对识别这些候选者的信心存在差异。大多数外科医生（59%）和非外科医生（61%）分别表示愿意进行手术并指导相关康复。两个组都没有报告患者依从性、获得康复服务的机会和可用的财务资源是主要障碍，但外科医生比非外科医生更有可能认为服务报酬不足（37%比 13%）。两个组都认为手术治疗复杂，应在多学科团队的环境中进行。
外科医生和非外科医生对 CP 上肢重建手术的看法存在差异。通过进行更高水平的研究、实施多专业教育推广、制定客观的转诊标准、增加手术报酬、增加接受过上肢外科培训的外科医生数量以及实施多学科 CP 诊所，可以解决重建的障碍。
