Deltoid triceps transfer and functional independence of people with tetraplegia

Study design: Matched case control study. Setting: Two regional spinal units-Salisbury, UK (surgical centre) and London, UK (control centre). Objective: To compare the functional independence and wheelchair mobility of spinal cord injured subjects, post deltoid triceps transfer, with matched control subjects. Methods: Two matched groups of subjects, with tetraplegia resulting in triceps paralysis, were studied. The surgical group consisted of five of the six patients who had previously undergone deltoid triceps transfer at Salisbury. The control group (n=6) had not undergone surgical intervention but were comparable with respect to level of lesion, age, age at injury and duration of disability. All subjects completed standardised assessments of activities of daily living (Functional Independence Measure-FIM) and wheelchair mobility (10 m push and figure of 8 push). Surgical subjects completed additional questions, regarding the perceived effects of surgery on function. Results: It was not possible to demonstrate absolute functional differences with the chosen outcome measures in this small series of matched case controls. All surgical subjects cited specific functional improvements since surgery and recommended the procedure. However the FIM lacked sufficient sensitivity to detect these changes. Conclusion: Further investigation of the functional outcome of deltoid triceps transfer in tetraplegia is warranted. Development of more sensitive outcome measures would be useful.