Measuring What Matters: Patient Perspectives on Success and Recovery After Nerve Injury.

Abstract

Peripheral nerve injuries have profound consequences for physical, psychological, and social functioning. Advances have improved outcomes; however, patients frequently experience residual symptoms and incomplete recovery. Traditional measures of success emphasize clinician-defined benchmarks, which may not fully capture the lived experience of recovery. This study explores how patients define "success" after nerve reconstruction, how these definitions align or diverge from those used by clinicians, and the contextual factors that shape patient perceptions of recovery. A qualitative study was conducted using semistructured interviews with 12 patients who had undergone surgical reconstruction for upper-extremity peripheral nerve injury. Interviews explored patients' reflections on expectations, recovery milestones, satisfaction, and patient-defined metrics of success. Thematic analysis was conducted using an inductive approach, guided by principles of critical disability theory, which emphasizes social and structural influences on disability and recovery. Patients described recovery as a dynamic process of redefining what success meant over time. Initially characterized by early optimism, recovery was often challenged by disrupted expectations, leading patients to recalibrate progress and ultimately redefine success in more personal terms. Satisfaction with recovery was marked less by physical symptoms alone and more by how recovery aligned with daily roles and valued activities, including maintaining confidence and independence, and was influenced by expectations set before surgery. Patients' definitions of success extended beyond clinical outcomes, reflecting a disconnect between clinical measures and lived recovery, shifting perceptions across time, and an emphasis on meaningful participation. Outcomes after peripheral nerve reconstruction cannot be fully captured by motor and sensory grading alone and may be too nuanced for current patient-reported outcome measures to quantify. Patients evaluated recovery in terms of role participation, independence, and quality of life, often redefining success as adaptation rather than restoration. These findings indicate that reliance on clinician-centered benchmarks risks oversimplifying the patient experience. Prognosis IV.