1
|
Watanabe T, Noto S, Natsumeda M, Kimura S, Ikarashi F, Tabata S, Takano M, Tsukamoto Y, Oishi M. Improvements in activities of daily living among patients with brain tumors are associated with age, baseline physical function, duration of rehabilitation, and tumor recurrence but not type. Int J Rehabil Res 2024:00004356-990000000-00104. [PMID: 39190364 DOI: 10.1097/mrr.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Genetic testing has improved the accuracy of diagnosis of brain tumors, and treatment is now tailored to the type of brain tumor. In contrast, the factors that influence the improvement in independence in activities of daily living (ADLs) following rehabilitation have not been clarified, particularly the role of tumor type. In this retrospective cohort study of 358 participants, we analyzed changes in the Functional Independence Measure (FIM) from pre-rehabilitation to post-rehabilitation provided in an acute care hospital. Multiple regression was used to determine whether FIM gain is associated with age, gender, preadmission Karnofsky Performance Status (KPS), number of rehabilitation days, average duration of daily therapy (min/day), and tumor recurrence and type (WHO grade 1, 2, 3, and 4 gliomas; primary central nervous system lymphomas; and metastatic brain tumors). The results showed that older age (β -0.183), tumor recurrence (β -0.137), preadmission KPS < 80 (β -0.180), and higher baseline total FIM score (β -0.470) were associated with lower FIM gain whereas the average duration of daily therapy (β 0.153) was associated with higher FIM gain. Brain tumor type was not associated with FIM gain. Improved independence in ADLs is more influenced by demographic, functional status, and treatment factors than differences in brain tumor type.
Collapse
Affiliation(s)
- Takahiro Watanabe
- Department of Clinical Technology, Niigata University Medical and Dental Hospital
- Department of Major in Rehabilitation Sciences, Niigata University of Health and Welfare Graduate School
| | - Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Shinji Kimura
- Department of Rehabilitation Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Fumie Ikarashi
- Department of Clinical Technology, Niigata University Medical and Dental Hospital
| | - Satoshi Tabata
- Department of Clinical Technology, Niigata University Medical and Dental Hospital
| | - Mayuko Takano
- Department of Clinical Technology, Niigata University Medical and Dental Hospital
| | | | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University
| |
Collapse
|
2
|
Natsume K, Yoshida A, Sakakima H, Yonezawa H, Kawamura K, Akihiro S, Hanaya R, Shimodozono M. Age-independent benefits of postoperative rehabilitation during chemoradiotherapy on functional outcomes and survival in patients with glioblastoma. J Neurooncol 2024:10.1007/s11060-024-04785-1. [PMID: 39078543 DOI: 10.1007/s11060-024-04785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE To investigate the impact of early and continuous postoperative inpatient rehabilitation during chemoradiotherapy on functional outcomes and overall survival (OS) in patients with glioblastoma (GBM), particularly in different age groups. METHODS This retrospective cohort study at a university hospital (2011-2016) included 75 of 119 consecutive patients newly diagnosed with GBM who underwent standardized treatment and postoperative rehabilitation. Patients were divided into older (≥ 65 years, n = 45) and younger (< 65 years, n = 30) groups, engaging in a 50-day rehabilitation program. We assessed rehabilitation progress, Barthel Index (BI), Brunnstrom Recovery Stage (BRS), adverse events, and OS. BI at discharge and survival were analyzed using multivariate and Cox regression models, respectively. RESULTS The mean age was 72.5 ± 6.3 and 52.4 ± 7.8 years in the older and younger groups, respectively. Both groups demonstrated significant improvements in BI and BRS. Despite more adverse events in the older group, no significant difference existed in median OS (older group: 18.7 months vs. younger group: 18.3 months, p = 0.87). Early walking training, reduced fatigue during chemoradiotherapy, and high Karnofsky Performance Status at admission significantly impacted the BI at discharge. Cox regression analysis identified the BI at discharge as a significant predictor of survival (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.97-0.99, p = 0.008). CONCLUSION Integrated rehabilitation improves functional outcomes, and enhanced ADL at discharge is associated with improved survival outcomes in patients with GBM, regardless of age. This highlights the need for personalized rehabilitation in treatment protocols. Further prospective studies are warranted to confirm these findings.
Collapse
Affiliation(s)
- Keisuke Natsume
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akira Yoshida
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hajime Yonezawa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shintaro Akihiro
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
3
|
Hunter H, Qin E, Wallingford A, Hyon A, Patel A. Neurorehabilitation for Adults with Brain and Spine Tumors. Semin Neurol 2024; 44:64-73. [PMID: 38049116 DOI: 10.1055/s-0043-1777407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.
Collapse
Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - April Hyon
- Department of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amar Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
4
|
Ullah S, Qureshi AZ, Rathore FA, Sami W, Moukais IS, Alibrahim FS, Asiri IA, Alsuhaibani A. Functional Outcomes of Patients with Primary Brain Tumors Undergoing Inpatient Rehabilitation at a Tertiary Care Rehabilitation Facility in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4679. [PMID: 36981589 PMCID: PMC10049031 DOI: 10.3390/ijerph20064679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Rehabilitation services play a crucial role in improving the functionality and quality of life of individuals with a brain tumor; however, outcomes of inpatient rehabilitation based on tumor characteristics are not well known in the literature. This study was carried out to evaluate the effects of tumor characteristics on functional outcomes. A retrospective chart review was conducted for all adults with a diagnosis of primary brain tumor admitted for IPR between January 2014 and December 2019. Information was collected regarding demographics, characteristics of primary brain tumors, length of stay (LOS) and Functional Independence Measurement (FIM) scores. There were 46 patients, with the majority being male. The most common brain tumors were glioblastoma multiforme and meningioma. The mean LOS was 47.93 ± 26.40 days and the mean FIM gain was 78 ± 14. The type, grade and location of primary brain tumors did not show a significant correlation with the length of stay and functional gains during inpatient rehabilitation. There was a positive correlation between the FIM at admission and discharge, and a significant inverse correlation between the FIM score at admission and LOS. In-patient rehabilitation improved the functional outcomes in adult patients with primary brain tumors. Strategies to incorporate IPR in the care continuum of patients with brain tumors need to be adapted to improve regional services.
Collapse
Affiliation(s)
- Sami Ullah
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 11525, Saudi Arabia
- Department of Physical Medicine and Rehabilitation, Qatar Rehabilitation Institute, Doha P.O. Box 3050, Qatar
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi 75530, Pakistan
| | - Waqas Sami
- College of Nursing, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Imad Saeed Moukais
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Fatimah Saif Alibrahim
- Department of Orthopedics, King Saud University Medical City, Riyadh 12372, Saudi Arabia
| | - Ibrahim Ali Asiri
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Ayman Alsuhaibani
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| |
Collapse
|
5
|
Reilly JM, Ruppert LM. Post-acute Care Needs and Benefits of Inpatient Rehabilitation Care for the Oncology Patient. Curr Oncol Rep 2023; 25:155-162. [PMID: 36729252 PMCID: PMC10423402 DOI: 10.1007/s11912-023-01366-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This study aims to assess recent literature published on the post-acute care needs of cancer patients, specifically focusing on the acute inpatient rehabilitation setting. RECENT FINDINGS The neurologic cancer population appears to be the most studied oncologic population in acute inpatient rehabilitation studies within the past 5 years. This finding is consistent with prior findings from the past several decades. Recent trends in inpatient cancer rehabilitation note a population with lower admission functional status and shorter lengths of stay compared to prior studies. Despite these findings, the percentage discharged to the community remains high. With new treatments yielding improved survival, cancer patients may live longer and risk accumulating more functional impairments. Physicians involved in their care must understand post-acute care needs and work in a multidisciplinary group to best determine post-acute disposition. This decision remains very individualized and should consider both oncologic and functional needs.
Collapse
Affiliation(s)
- Julia M Reilly
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 E 53rd St, New York, NY, USA.
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, NY, USA.
| | - Lisa Marie Ruppert
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 E 53rd St, New York, NY, USA
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, NY, USA
| |
Collapse
|
6
|
Frequency and reasons for unplanned transfer to the primary acute care service of inpatient rehabilitation glioblastoma multiforme patients. Support Care Cancer 2023; 31:122. [PMID: 36653554 DOI: 10.1007/s00520-023-07591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine the percentage of and factors associated with unplanned transfer to the acute care service of glioblastoma multiforme acute rehabilitation inpatients. METHODS Retrospective review of glioblastoma multiforme acute rehabilitation inpatients admitted 4/1/2016-3/31/2020 at a National Cancer Institute Comprehensive Cancer Center. RESULTS One hundred thirty-nine consecutive admissions of unique glioblastoma multiforme acute rehabilitation inpatients were analyzed. Fifteen patients (10.7%, 95% confidence interval 6.5-17.1%) were transferred to the acute care service for unplanned reasons. The most common reasons for transfer back were neurosurgical complication 6/15(40%), neurologic decline due to mass effect 4/15(26.7%), and pulmonary embolism 2/15(13.3%). Older age (p = 0.010), infection prior to acute inpatient rehabilitation transfer (p = 0.020), and lower activity measure of post-acute care 6-click basic mobility scores (p = 0.048) were significantly associated with transfer to the acute care service. Patients who transferred to the acute care service had significantly lower overall survival than patients who did not transfer off (log-rank test p = 0.001). CONCLUSION Acute inpatient physiatrists should closely monitor patients for neurosurgical and neurologic complications. The variables significantly associated with transfer to the acute care service may help identify patients at increased risk for medical complications who may require closer observation.
Collapse
|
7
|
Pieczyńska A, Pilarska A, Hojan K. Predictors of functional outcomes in adults with brain tumor undergoing rehabilitation treatment: a systematic review. Eur J Phys Rehabil Med 2022; 58:666-674. [PMID: 35801976 PMCID: PMC10019483 DOI: 10.23736/s1973-9087.22.07510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The number of diagnosed brain tumors (BT) has increased in recent years. The results of treatment of patients with surgery, chemotherapy and radiotherapy are also improving and their survival rate has increased significantly. Symptoms of the disease and side effects of oncological treatment may reduce the functional performance of patients. It is so important to conduct rehabilitation in this group of patients. The aim of this systematic review is to identify predictors of effective rehabilitation in aspects of physical functioning of BT patients. The study was registered with health and social care, welfare, public health, education, crime, justice and international development departments, where there is a health-related interest outcome PROSPERO. We have received registration number is: CRD42021269398. EVIDENCE ACQUISITION To find relevant publications, the algorithm of keywords ("brain tumor") AND (rehabilitation OR "physical activity" OR exercise OR "physical therapy") was used. The search was conducted in PubMed, Web of Science, PEDro, ClinicalTrials.gov and Cochrane Library. Information was extracted using the PICO format (i.e., participants, intervention, comparison, outcomes). EVIDENCE SYNTHESIS the initial search identified a total of 1122 results, and 21 articles met the criteria and were selected for analysis. CONCLUSIONS The results present that rehabilitation is an important and safe cancer encouraging therapy, brings functional benefits. The type of rehabilitation program, especially in BT patients, depends on many factors such as time and type of oncological treatment, general conditions which is strongly related to the general functioning of the patient. It still is a need for clinical research into the safety and effectiveness of rehabilitation interventions already during radio or chemotherapy in this group of cancer patients.
Collapse
Affiliation(s)
- Anna Pieczyńska
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland - .,Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland -
| | - Agnieszka Pilarska
- Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland.,Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
| |
Collapse
|
8
|
Watanabe T, Noto S, Natsumeda M, Kimura S, Tabata S, Ikarashi F, Takano M, Tsukamoto Y, Oishi M. Characteristics of health-related quality of life and related factors in patients with brain tumors treated with rehabilitation therapy. J Patient Rep Outcomes 2022; 6:94. [PMID: 36068453 PMCID: PMC9448840 DOI: 10.1186/s41687-022-00499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rehabilitation therapy during hospitalization is effective in improving activities of daily living (ADL) and physical function in patients with brain tumors. However, there are few studies on the effect of rehabilitation therapy on health-related quality of life (HRQOL) in patients with brain tumors. Additionally, the EuroQol-5Dimension-5Level (EQ-5D-5L) index score has not been reported as an outcome. This study aimed to investigate the HRQOL of patients with brain tumors who underwent rehabilitation therapy and investigated the factors affecting the EQ-5D-5L index score from various perspectives, including various brain tumor type and recurrence. In addition, we examined the relationship between the EQ-5D-5L index score, disease-specific HRQOL scale, and ADL.
Methods
Patients with brain tumors who underwent treatment and rehabilitation at Single tertiary care academic medical center were included in this cross-sectional study. We used the EQ-5D-5L, European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire core 30, and EORTC quality of life questionnaire brain cancer module to evaluate HRQOL. ADL were assessed using the functional independence measure (FIM). The relationship between each HRQOL assessment score and the FIM was analyzed, and the influence of related factors was assessed by multiple regression analysis.
Results
This study included 76 patients. The EQ-5D-5L index score was 0.689 for all patients with brain tumors and 0.574 for those with glioblastomas, which was the lowest value. There was a moderate correlation between the EQ-5D-5L index score and FIM (r = 0.627, p < 0.001). In addition, the EQ-5D-5L index score was significantly correlated with most of the items of the disease-specific HRQOL scale. Multiple regression analysis revealed that glioblastoma histology (coefficient: − 0.373, p = 0.005) and recurrence (coefficient: − 0.273, p = 0.020) were independent factors affecting the EQ-5D-5L index score.
Conclusions
Patients with glioblastoma undergoing rehabilitation have reduced HRQOL, which was influenced by glioblastoma histology and recurrence.
Collapse
|
9
|
Long-Term Outcomes of Patients with Primary Brain Tumors after Acute Rehabilitation: A Retrospective Analyses of Factors. Life (Basel) 2022; 12:life12081208. [PMID: 36013388 PMCID: PMC9410350 DOI: 10.3390/life12081208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022] Open
Abstract
Although primary brain tumors are relatively rare, they cause significant morbidity and mortality due to the high rates of neurological impairment. The purpose of this study was to examine the physical and functional outcomes of patients with primary brain tumors who had undergone inpatient rehabilitation. This was a retrospective study which recruited 163 patients who had been admitted for inpatient rehabilitation. Rehabilitation outcomes, including the Functional Independence Measure (FIM) and Glasgow Outcome Scale (GOS), were recorded up to 1 year post-discharge. The majority of patients (79.1%) had low-grade (WHO Class I-II) tumors, 35 (21.5%) were diagnosed with GBM and 52 (31.9%) had recurrent brain tumors. Rehabilitation outcomes were sustained, with 125 (76.7%) and 113 (69.3%) patients having a GOS of ≥4 at 6 months and 1 year after discharge, respectively. A GOS of ≥4 at 1 year was negatively associated with high-grade tumors (p < 0.001) and radiotherapy (p = 0.028), and positively associated with a higher discharge FIM motor score (p < 0.001) and the presence of a caregiver after discharge (p = 0.034). Our study demonstrates significant positive functional benefits from 4 weeks of inpatient neuro-oncological rehabilitation for patients with primary brain tumors, as well as the importance of supportive care from caregivers.
Collapse
|
10
|
Knowlton SE, Gundersen AI, Reilly JM, Tan CO, Schneider JC, Shih SL. Predictors of Acute Transfer and Mortality Within 6 Months From Admission to an Inpatient Rehabilitation Facility for Patients With Brain Tumors. Arch Phys Med Rehabil 2022; 103:424-429. [PMID: 34762854 PMCID: PMC9446107 DOI: 10.1016/j.apmr.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To obtain useful information for clinicians in evaluating patients with brain tumors for transfer to and subsequent care in inpatient rehabilitation facilities (IRFs). DESIGN Retrospective chart review. SETTING Inpatient rehabilitation facility. PARTICIPANTS A total of 208 adults with either initial or recurrent brain tumors who were admitted to an IRF between January 2017 and December 2018 after an acute hospitalization. INTERVENTIONS None MAIN OUTCOME MEASURES: Transfer from an IRF to an acute care hospital and mortality within 6 months from admission to an IRF. RESULTS Of the 208 patients who met inclusion criteria, 20.2% were transferred to an acute care hospital during the IRF stay, which was associated with prior chemotherapy, steroid use, and laterality of tumor. In total, 36.9% of patients with brain tumors died within 6 months of an IRF admission that was associated with recurrent tumor diagnosis, prior chemotherapy, prior neurosurgical intervention, prior neurostimulant use, use of steroids, isocitrate dehydrogenase and O6-methyl-guanyl-methyl-transferase biomarkers, and laterality and location of tumor. CONCLUSIONS Patients with brain tumors have a notable potential for acute hospital transfer and mortality within 6 months of IRF stay, with several tumor- and treatment-related risk factors. This information can help identify functional goals, identify high risk patients, enable closer clinical monitoring, and facilitate focused care discussions at IRFs.
Collapse
Affiliation(s)
- Sasha E. Knowlton
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra I. Gundersen
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | | | - Can Ozan Tan
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Shirley L. Shih
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
11
|
Chowdhury N, Scott C, O'Dell MW. Recovery in glioblastoma multiforme during inpatient rehabilitation is equivalent in first versus repeat resection: A 10-year retrospective analysis. PM R 2021; 14:40-45. [PMID: 33583134 DOI: 10.1002/pmrj.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inpatient rehabilitation improves function in people with brain tumors, including glioblastoma multiforme (GBM) but there are limited data on the impact of multiple resections on outcomes. We hypothesize that outcomes will be more favorable for those patients with a single resection when compared to those with more than one resection. OBJECTIVE To examine functional outcomes in inpatient rehabilitation for people with GBM who underwent one or more resections prior to admission. DESIGN Retrospective analysis. SETTING Inpatient rehabilitation unit within a large, urban, academic medical center. PARTICIPANTS Patients who were admitted to our institution for the treatment of initial GBM or GBM recurrence necessitating surgical resection or repeat resection. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Total FIM Change, Total Functional Independence Measure (FIM) Efficiency, Motor and Cognitive FIM efficiency, and proportion discharged home. RESULTS From 2006 to 2016, 94 persons with GBM were admitted. Eight were readmissions classified as "repeat" and another seven transferred to the medical floor and excluded. Of the 79 patients included, 56 were first and 23 second resections, with a group mean age of 62.7 + 12.2 years and were 51% male. On analysis of covariance, change in FIM score from admission to discharge was insignificant between groups, adjusted for age and acute care length of stay (17.1 vs. 17.4, F[1, 75] = 0.027, P = .871). Likewise, the proportion of home discharge was not significant between groups (chi-square, 75.0% vs. 78.3%, P = .758). CONCLUSIONS Patients who have undergone second resections for GBM are reasonable candidates for admission to the inpatient rehabilitation units despite carrying a poor prognosis and having multiple exposures to surgical morbidity. Factors to take into account are that candidates considered for a second resection may be relatively younger or healthier and therefore may perform better from a functional standpoint. In addition, postoperative steroid administration may play a role in the similarities the authors noted. A larger, multicenter study should validate our findings (limited by sample size and a single location) and identify factors predicting a successful outcome.
Collapse
Affiliation(s)
- Nasim Chowdhury
- Department of Rehabilitation Medicine, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Charles Scott
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
12
|
Zhao K, Yu C, Gan Z, Huang M, Wu T, Zhao N. Rehabilitation therapy for patients with glioma: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23087. [PMID: 33157978 PMCID: PMC7647558 DOI: 10.1097/md.0000000000023087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Glioma is the most common type of brain tumor because of the destructiveness of the disease itself and the side effects of treatment, patients often leave symptoms of neurological defects. At present, rehabilitation treatment is not popular in glioma patients. There is a lack of definite evidence to prove the benefits of rehabilitation therapy for glioma patients. The purpose of this meta-analysis is to determine whether rehabilitation therapy can significantly improve the prognosis of neurological function and improve the quality of life of patients with glioma. METHODS The articles about rehabilitation treatment of glioma in Cochrane, PubMed, and Embase, Web of Science, and Medline database from January 1990 to May 2020 were searched. Before rehabilitation as the control group, after rehabilitation as the experimental group. The Functional Independence Measure (FIM) was used as the outcome index, including total FIM, motor FIM, and cognitive FIM. Use STATA12.0 for meta-analysis. RESULTS A total of 8 articles were included in the study, with a total of 375 glioma patients. Meta-analysis of total FIM (SMD = 0.96, 95%CI = 0.66-1.26, P < .001), motor FIM (SMD = 0.75, 95%CI = 0.54-0.96, P < .001) and cognitive FIM (SMD = 0.35, 95%CI = 0.19-0.50, P < .001) indicated that the neurological function of rehabilitation was significantly improved in total, motor and consciousness. CONCLUSION The published studies show that rehabilitation therapy can improve the functional prognosis and quality of life of glioma patients. More attention should be paid to the therapeutic value of rehabilitation for glioma patients in the future. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020188740.
Collapse
Affiliation(s)
- Kai Zhao
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Chaojun Yu
- Neurosurgery Department, 903 Hospital, Jiangyou City, Sichuan Province
| | - Zhichao Gan
- Neurosurgery Department, Xinyang Central Hospital, Xinyang, Henan Province, China
| | - Minhao Huang
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Tingting Wu
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Ninghui Zhao
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| |
Collapse
|
13
|
Thakkar P, Greenwald BD, Patel P. Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review. Brain Sci 2020; 10:brainsci10080492. [PMID: 32751074 PMCID: PMC7464729 DOI: 10.3390/brainsci10080492] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/16/2022] Open
Abstract
Rehabilitative measures have been shown to benefit patients with primary brain tumors (PBT). To provide a high quality of care, clinicians should be aware of common challenges in this population including a variety of medical complications, symptoms, and impairments, such as headaches, seizures, cognitive deficits, fatigue, and mood changes. By taking communication and family training into consideration, clinicians can provide integrated and patient-centered care to this population. This article looks to review the current literature in outpatient and inpatient rehabilitation options for adult patients with PBTs as well as explore the role of the interdisciplinary team in providing survivorship care.
Collapse
Affiliation(s)
- Parth Thakkar
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA; (P.T.); (P.P.)
| | - Brian D. Greenwald
- JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA
- Correspondence:
| | - Palak Patel
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA; (P.T.); (P.P.)
| |
Collapse
|