Bringing Patient Advisors to the Bedside of Digit Replantation Patients

Abstract

Purpose: Patient advisors are peer volunteers who have already been through a digit replantation. They are fully trained and viewed as full-fledged members of the care team. This proof-of-concept study was aimed at describing a model of care that brings patient advisors directly to the patient’s bedside. In this model, the patients’ perception of disability, the adherence to the rehabilitation process, and overall satisfaction were reported. Methods: A prospective pilot study was conducted from July 2014 to June 2015. All patients admitted to a center of expertise were offered the option to interact with patient advisor at bedside. Meetings were generally brief (15-30 minutes) and were proposed on the fifth day postsurgery as well as 8 and 16 weeks following surgery. The Disabilities of the Arm, Shoulder and Hand (DASH; 30 items scored 1-5) questionnaire was completed at 8 and 16 weeks follow-up as a measure of self-rated upper extremity disability and symptoms. All patients who had at least 1 interaction with a patient advisor were interviewed by telephone after study completion. The purpose of the interviews was to understand their expectations, the contribution of the patient advisor in their own care, and any possible reluctance or difficulty encountered (particularly when interactions were conducted via videoconferencing). Adherence to the rehabilitation process was also recorded and later compared to an estimate of 35% adherence generated from our Institution. Results: Based on an average of 9 patients, the DASH score completed at week 16 (27.6) showed a decrease of 33.8% when compared with that of week 8 (41.7). Adherence to treatment plan was respected in 55% of patients with patient advisor’s interaction, which was higher than estimations. Several key roles of the patient advisors emerged from the 18 interviews conducted on patients. Patient advisor is perceived as a care team member who will listen and support the patient, simplify the information conveyed by the care team, and finally break the patients’ loneliness, increasing their motivation toward the rehabilitation process. Conclusion: This study underlines the potential of patient advisors to improve the perception of disability and the adherence to the rehabilitation process in patients who have undergone digits replantation. Measurements of hand strength, range of motion, and sensibility as well as self-reported pain, posttraumatic stress disorder, and self-esteem were also performed; analyses are ongoing at present time. Further researches are required before widespread dissemination of the usefulness of patient advisors.