Bartolo 2012

Methods

Case‐control study, Italy

Participants

N = 150; Intervention: N = 75 with brain tumours (meningioma and glioblastoma), control: N = 75 with stroke

Inclusion: all admitted patients to an inpatient neurorehabilitation unit after surgery for brain tumours (meningiomas or glioblastomas) over a 2‐year period (2007‐2009). Control participants were stroke patients (ischaemic or haemorrhagic), matched one‐to‐one for age, sex, and side of lesion

Exclusion: people with oligoastrocytoma, oligodendroglioma, and ependymomas in order to obtain homogenous group

Interventions

Inpatient multidisciplinary rehabilitation administered by experienced physical therapists, 60‐min session, 6 days/week for 4 consecutive weeks, which included passive/assisted stretching exercises, strengthening exercises, balance exercises, ground‐floor walking (including step control), and 4 weeks of speech therapy (individual 60‐min sessions, once daily, 6 days/week) when aphasia was diagnosed

Outcomes

Sitting balance, standing balance, Hauser Index: gait disorders, MGHFAC: severity of gait disorders, FIM

Assessment time points

Before and after the intervention

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: case‐control study

• Intervention did not include input from other disciplines, apart from speech pathologists. Also unclear if all the participants in the intervention group and control group received a similar programme

• No sample size calculation performed

Quality rating of the study

Very low

Fu 2010

Methods

Retrospective case‐control study, USA

Participants

N = 42; Intervention: N = 21 with low‐grade gliomas, control: N = 21 with high‐grade gliomas

Inclusion: all patients admitted to an inpatient acute rehabilitation programme between 1996 and 2008. 21 of 443 with high‐grade and 21 of 24 with low‐grade astrocytoma were selected

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; LOS; discharge‐to‐home rate

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: N/A

Free of selective reporting: Yes

Other bias:

• Study design: retrospective (medical records) case‐control

• Contents, duration, and nature of multidisciplinary rehabilitation programme not described

• Unclear selection criteria. Selected patients reported to have "adequate medical records", with the implication that patients who were not selected may not have had "adequate medical records"

Quality rating of the study

Very low

Geler‐Kulcu 2009

Methods

Case‐control study, Turkey

Participants

N = 42; Intervention: N = 21 with brain tumours (benign and malignant), control: N = 21 with stroke

Inclusion: all admitted patients to an inpatient neurorehabilitation unit, control participants were stroke patients (ischaemic or haemorrhagic), matched by side of lesion

Exclusion: people with oligoastrocytoma, oligodendroglioma, and ependymomas in order to obtain homogenous group

Interventions

Inpatient "conventional" rehabilitation programme, single 60‐min sessions, 5 days/week for 4 consecutive weeks, which included physiotherapy and occupational therapy (if needed). Physiotherapy focused on positioning, postural control, range of motion, and progressive resistive exercises together with endurance and gait. Patients were discharged when their functional level was considered sufficient to allow them to participate in outpatient rehabilitation

Outcomes

PAS for Stroke, BBS, MAS, FIM (mobility)

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear 

Free of selective reporting: Yes

Other bias:

• Study design: case‐control study

• Intervention not adequately described and did not include input from other disciplines apart from PT and OT

• No sample size calculation performed

Quality rating of the study

Very low

Greenberg 2006

Methods

Retrospective case‐control study, Israel

Participants

N = 1828; Intervention N = 168  with brain tumours (128 meningiomas, 40 gliomas), control: N = 1660 with stroke (ischaemic or haemorrhagic)

Inclusion: all admitted patients to an inpatient neurorehabilitation unit over an 11‐year period (1993‐2004)

Interventions

Inpatient multidisciplinary rehabilitation provided by PT, medical staff, OT, and speech pathologist. Details of the multidisciplinary rehabilitation not provided

Outcomes

FIM, FIM efficiency, LOS days, discharge destination (rate discharge to home)

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: No

Free of selective reporting: Yes

Other bias:

• Study design: retrospective, case‐control, compared with unmatched control cohort

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

• No sample size calculation performed

Quality rating of the study

Very low

Huang 2001a

Methods

Prospective case series, USA

Participants

N = 10 (brain tumour)

Inclusion: all admitted patients to an inpatient neurorehabilitation unit over a 1‐year period (1999‐2000)

Interventions

Inpatient multidisciplinary rehabilitation that included: OT, rehabilitation therapy, recreational therapy, speech therapy, PT, rehabilitation nursing and case management

Outcomes

FIM, DRS, KPS, FACT‐BR

Assessment time points

Admission and discharge, post hoc analysis at 3‐month postdischarge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: case‐series study, no control group

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

• Small sample size

Quality rating of the study

Very low

Huang 2000

Methods

Retrospective case‐control, USA

Participants

N = 156; Intervention: N = 78 with primary or metastatic brain tumours (benign and malignant), control: N = 78 with traumatic brain injury matched by age and side of lesion

Inclusion: evaluation by a physiatrist for the following criteria: medical stability, need for therapy from more than one discipline, demonstration of gains with acute‐care therapies, potential to tolerate 3 hours of therapy, willingness and motivation to participate in a rehabilitation programme

Exclusion: patients who did not complete rehabilitation due to medical complications or death

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; FIM efficiency; LOS; discharge destination to community rate

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case‐control

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

• Unclear selection criteria: medically stable, motivated, and interested candidates only were selected by a single physiatrist for multidisciplinary rehabilitation with support arrangements for discharge to the community

Quality rating of the study

Very low

Huang 1998

Methods

Retrospective case‐control study, USA

Participants

N = 126; Intervention: N = 63 with primary or metastatic brain tumours (benign and malignant), control: N = 63 with stroke, case matched by age, gender, and side of lesion

Inclusion: all patients admitted to an inpatient rehabilitation centre

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; FIM efficiency; LOS; discharge destination to community rate

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case‐control study

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

Quality rating of the study

Very low

Kim 2012

Methods

Cohort study without control, Korea

Participants

N = 25 with brain tumours

Inclusion: all admitted patients to an inpatient neurorehabilitation unit after surgery (resection) for brain tumours (benign or malignant) over a 1‐year period (1 July 2008 to 30 June 2009), able to follow simple commands, as determined by scores ≥ 24 on the Korean version of the Mini‐Mental State Examination

Exclusion: those unable to complete a questionnaire because of a severe aphasia or a cognitive deficit, or who were clinically unstable, either medically or surgically

Interventions

Inpatient rehabilitation (4 weeks); details not provided

Outcomes

Fatigue severity: PFS, BFI

Mood status: BDI

Motor impairment: MI

Functional status: KPS, MBI

QoL: EORTC QLQ‐C30

Assessment time points

Before and after the intervention

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: cohort study without control group

• Contents, duration, and nature of rehabilitation intervention not described

• Small sample size and no sample size calculation

• High dropout rate: 9/25 participants (36%)

Quality rating of the study

Very low

Marciniak 2001

Methods

Retrospective case series, USA

Participants

N = 132 participants divided into 4 groups: astrocytomas 26%, meningiomas 33%, metastatic tumours 16%, other tumours 25%. Participants also grouped into those with tumour recurrence and those with initial tumour presentation

Inclusion: all  patients > 18 years, inpatient rehabilitation within a 3‐year period (1993‐1996)

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; FIM efficiency; LOS; discharge destination to home rate

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case series without control

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

Quality rating of the study

Very low

O’Dell 1998

Methods

Retrospective case‐control, USA

Participants

N = 80; Intervention: N = 40 participants with brain tumours (benign and malignant), control: N = 40, case matched by admission FIM score, age, and gender to 40 participants with traumatic brain injury

Inclusion: all  patients admitted to an inpatient acute rehabilitation programme over a 2‐year period (1994‐1996)

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; LOS; discharge destination to home rate

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case‐control

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

Quality rating of the study

Very low

Pace 2007

Methods

Prospective case series (before and after) study, Italy

Participants

N = 121 with malignant brain tumours

Inclusion: all patients discharged from hospital over 3‐year period (2000‐2003) with neurological deficits

Intervention

Home neurorehabilitation programme including physiotherapy 1 hour/3 times a week for 3 months, neurologist evaluation, psychological assistance, nursing and palliative care team if needed (further details not provided)

Outcomes

BI, KPS, EORTC QLQ‐C30

Assessment time points

Before and 3 months after rehabilitation

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Patients who completed only basal questionnaire were excluded

Free of selective reporting: Yes

Other bias:

• Study design: prospective before‐after study without control

• Contents, duration, and nature of multidisciplinary rehabilitation (intervention) not clearly defined

Quality rating of the study

Very low

Sherer 1997

Methods

Retrospective case series, USA

Participants

N = 13 (primary malignant brain tumours with a history of surgical resection, radiation, and chemotherapy)

Inclusion: all patients receiving outpatient rehabilitation who had a diagnosis of malignant brain tumour and adequate medical records to characterise their tumour and courses of therapy

Intervention

Outpatient rehabilitation with input from psychologists, speech/language pathologists, OT, and vocational specialists. Participants received an average of 2.6 ± 1.9 months of therapy (duration of 5 hours/day) (further details not provided)

Outcomes

Level of independence, vocational (productivity) outcomes

Assessment time points

Admission, discharge, and 8‐months follow‐up

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Yes

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case series without control

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

• Small sample size

• No validated measures used

Quality rating of the study

Very low

Tang 2008

Methods

Retrospective case series, Canada

Participants

N = 63 with primary and metastatic brain tumours, divided into 3 groups: glioblastoma multiforme 29%; metastatic tumours 40%; and various other primary brain tumours 31%

Inclusion: all patients admitted to an inpatient rehabilitation ward over a 3‐year period (2003‐2006)

Exclusion: patients with meningiomas

Intervention

Inpatient multidisciplinary rehabilitation (details not provided)

Outcomes

FIM; FIM efficiency; LOS; discharge destination to home rate; survival

Assessment time points

Admission and discharge

Risk of bias

Adequate sequence generation: No

Adequate allocation concealment: No

Blinding: No

Incomplete outcome data addressed: Unclear

Free of selective reporting: Yes

Other bias:

• Study design: retrospective case series without control

• Contents, duration, and nature of multidisciplinary rehabilitation not clearly defined

Quality rating of the study

Very low

Bartolo 2012

Statistical analysis

Student’s t test, Chi² test,  Wilcoxon matched‐pairs signed‐rank test, Mann‐Whitney U test, Kruskal–Wallis ANOVA

Results

• All the measures of outcome (FIM: mobility, ADL, cognition; balance tests, MGHFAC) were indicative of substantial improvements for brain tumour and stroke patients (P = 0.000 for all).

• The values of functional gain in all scores were comparable between brain tumour and stroke groups.

• Analysis of subgroups showed that people affected by meningioma achieved better results (in efficiency terms) as regards independence in ADL (P = 0.02) and mobility (P = 0.04) compared with people affected by glioblastoma or stroke.

• No statistically significant differences were found on other clinical scales.

Author’s conclusions

Rehabilitation after surgery can improve functional outcome, justifying the delivery of rehabilitation services, even during the acute phase, to brain tumour inpatients, irrespective of tumour type

Fu 2010

Statistical analysis

Descriptive analysis, Chi² test, Kruskal‐Wallis test, Mann‐Whitney U test

Results

• Both groups made statistically significant functional gains in their total FIM scores, ADL, and mobility FIM score from admission to discharge (P < 0.05 for all).

• Significantly greater gains were noted in high‐grade astrocytoma for total FIM (22 vs. 13, P = 0.02) and cognition FIM subscores (4.6 vs. 1.7, P = 0.04) compared with low‐grade astrocytoma.

• FIM efficiency was comparable between groups (1.9 high‐grade astrocytoma vs. 1.8 low‐grade astrocytoma, P = 0.8).

• Mean length of stay in the rehabilitation unit for people with high‐grade astrocytoma was significantly longer than for low‐grade (13 vs. 9 days, P = 0.04).

• Discharge to home rate was also comparable between groups: 90% in both groups.

Author’s conclusion

All participants made significant functional gains from admission to discharge. Compared with people with low‐grade astrocytoma, people with high‐grade astrocytoma had higher total FIM gain but also longer LOS. FIM efficiencies were comparable between the groups

Geler‐Kulcu 2009

Statistical analysis

Freidman test, Chi² test, Mann‐Whitney U test, ANOVA

Results

• Both groups improved significantly in terms of PASS, BBS, MAS, and FIM mobility scores (all P < 0.05).

• There was no statistically significant difference between the two groups with respect to any of the four outcome measures.

• There was no statistically significant difference between the groups in any of the four outcome measures when compared between people with different forms of brain tumours and people with stroke.

Author’s conclusions

People with brain tumour progressed as well as people with stroke in a post‐acute inpatient rehabilitation programme

Greenberg 2006

Statistical analysis

Descriptive statistics, analysis of variance

Results

• Functional variables during inpatient multidisciplinary rehabilitation were found to be similar in all the groups: average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group (P = 0.16); average discharge FIM rating was 90.3 for people with meningiomas, 80.7 for people with gliomas, and 87.8 for people with stroke (P = 0.76).

• There was no significant difference in functional gain among groups: functional gain was 17.9 for people with meningioma, 17.2 for people with glioma, and 21.8 for people with stroke (P = 0.4).

• FIM efficiency analysis showed that both brain tumour groups had similar efficacy and that people with stroke had the lowest efficiency (P = 0.001).

• Average LOS was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for the stroke group.

• 88.1% of people with stroke, 91.7% of people with meningioma, and 82.7% of people with glioma were discharged to their homes, and 5.4%, 3.4%, and 8.6%, respectively, were discharged to nursing homes.

Author’s conclusions

Both people with gliomas and people with meningiomas hospitalised for inpatient rehabilitation improved their FIM ratings after a short inpatient multidisciplinary rehabilitation. Both groups had high rates of discharge to the community

Huang 2001a

Statistical analysis

ANOVA, Spearman’s correlation analysis, Bonferroni statistical test

Results

• Improvement in total functional outcome was indicated by all 3 functional measures (FIM: P < 0.05; DRS: P < 0.05; KPS: P < 0.05).

• Significant improvements were found between admission and discharge scores for the FIM and DRS.

• KPS revealed significant improvement between admission and 3‐months follow‐up scores.

• All admission and discharge functional scales (FIM, DRS, KPS) correlated significantly with each other.

• No significant change was noted in the FACT‐BR between admission and discharge scores, but FACT‐BR scores did improve at 1‐ and 3‐months postdischarge relative to admission.

• FIM, KPS, and DRS did not show significant correlation with FACT‐BR.

• 90% of participants were initially discharged to a home environment.

Author’s conclusion

Although participants made functional gains during and after inpatient multidisciplinary rehabilitation, gains in QoL were not significant until 1‐month postdischarge. QoL does not appear to correlate well with functional outcomes. Furthermore, the KPS is less sensitive than the FIM and DRS in detecting change in functional status

Huang 2000

Statistical analysis

ANOVA, Chi² test

Results

• Both groups improved significantly for FIM score at discharge (P < 0.01).

• Change in FIM score was significantly greater in the traumatic brain injury group for total FIM score (P < 0.01), ADL FIM score (P < 0.01), and mobility FIM score (P < 0.01).

• No differences were noted for change in cognitive FIM between groups (P = 0.06).

• FIM efficiency was similar between groups (FIM change per week: 10 tumour vs. 11.3 traumatic brain injury, P = 0.3).

• LOS was significantly shorter in tumour group (22 days vs. 32 days, P < 0.01).

• Discharge community rate was significantly greater in tumour group (87%) vs. traumatic brain injury group (74%) (P < 0.05).

Author’s conclusion

People with brain tumour can achieve comparable functional outcome and have a shorter rehabilitation length of stay and greater discharge to community rate than people with traumatic brain injury

Huang 1998

Statistical analysis

ANOVA, Chi² test

Results

• Both groups improved significantly for FIM score at discharge.

• FIM change was comparable between groups (23.6 brain tumour vs. 29.1 stroke, P = 0.08)

• Change in ADL FIM score was significantly greater in stroke group (10.8 vs. 8.3, P = 0.03). No differences were noted for change in motor and cognitive FIM between groups.

• FIM efficiency was comparable between groups (FIM change/week: 8.4 brain tumour vs. 7.2 stroke, P = 0.29).

• LOS was significantly shorter in brain tumour group (25 days vs. 34 days, P < 0.01).

• Discharge to community rate was comparable between groups (86% for brain tumour vs. 94% for stroke) (P = 0.06).

Author’s conclusion

People with brain tumour can achieve comparable functional outcome and discharge to community rate, and have a shorter rehabilitation length of stay than people with stroke

Kim 2012

Statistical analysis

Mann–Whitney test, Spearman’s correlation analysis, Wilcoxon signed‐rank tests

Results

• Fatigue correlated significantly with the KPS, MBI, and EORTC QLQ‐C30 physical functioning and insomnia scales.

• Insomnia was a significant predictor of fatigue before rehabilitation (P = 0.004).

• Baseline fatigue scales, MBI, MI, and EORTC QLQ‐C30 physical functioning scale were the important independent predictors of fatigue after rehabilitation.

• After 4 weeks rehabilitation, there was significant improvement in KPS (50.0 ± 11.5 vs. 59.4 ± 13.4, P = 0.04), MBI (47.2 ± 27.0 vs. 72.2 ± 28.1, P < 0.01), MI (56.2 ± 20.6 vs. 63.4 ± 14.0, P < 0.01), whereas total PFS and BFI scores did not change.

• Participants with a moderate level of fatigue showed significant improvement in the PFS (5.2 ± 0.5 vs. 3.1 ± 1.6, P = 0.02), KPS (47.1 ± 9.5 vs. 64.3 ± 11.3, P = 0.02), MBI (45.7 ± 28.8 vs. 69.1 ± 37.8, P = 0.04), MI scores (64.1 ± 11.7 vs. 70.6 ± 9.2, P = 0.03), and participants with a mild level of fatigue significantly improved in the MBI score (56.3 ± 29.6 vs. 77.9 ± 24.4, P = 0.04).

Author’s conclusion

The findings suggest that people with brain tumours commonly complain of a moderate level of fatigue, which may reduce daily functioning and quality of life, with sleep disturbance being a significant predictor of fatigue. During rehabilitation, functional outcomes and motor power showed improvements in those people, not aggravating fatigue

Marciniak 2001

Statistical analysis

Descriptive analysis, analysis of variance

Results

• All groups made significant functional gains in their FIM score, and motor and cognitive FIM subscores from admission to discharge.

• Total FIM change was comparable between tumour groups.

• The change in FIM motor subscores was significantly smaller for those with metastasis (8.6) and astrocytomas (16.2) when compared with meningiomas (20) and other tumours (21).

• The tumour recurrence group had significantly lower motor FIM gains (13.4 vs. 21.4), and FIM efficiency (0.55 vs. 0.98), lower discharge motor FIM scores (50.1 vs. 63.1) compared to those receiving rehabilitation after initial tumour treatment.

• Participants who received radiation during rehabilitation had significantly greater motor efficiency score (1 ± 0.79) than those who did not (P < 0.05).

• Participants in the metastatic disease group had significantly shorter LOS than other tumour groups (P = 0.03).

• Overall, 65% of the 132 admissions were discharged home. People with meningiomas were less likely to be discharged home (47%) than those with metastatic tumours (71%), astrocytic tumours (71%), or those in the other tumours group (79%) (P = 0.01).

Author’s conclusion

Metastatic or primary brain tumour type does not affect the efficiency of functional improvement during inpatient multidisciplinary rehabilitation. People receiving concurrent radiation therapy make greater functional improvement per day than those not receiving radiation. People with recurrent tumours make significantly smaller functional motor gains than those completing inpatient multidisciplinary rehabilitation after the initial diagnosis of the tumour

O’Dell 1998

Statistical analysis

Descriptive analysis, Chi² test, Kruskal‐Wallis test, Mann‐Whitney U test

Results

• Both groups made significant functional gains in their FIM scores: total FIM, ADL and mobility subscores from admission to discharge.

• Total FIM change was significantly greater in the traumatic brain injury group compared to the brain tumour group (35 vs. 25, P < 0.02).

• FIM efficiency was comparable between groups: 1.9 for traumatic brain injury vs. 1.5 for brain tumour.

• LOS was comparable between groups: 22 days for traumatic brain injury vs. 18 days for brain tumour.

• Discharge to home rate was also comparable between groups: 93% for traumatic brain injury vs. 83% for brain tumour.

Author’s conclusion

Daily functional gains made by people with brain tumour undergoing multidisciplinary rehabilitation were similar to those made by people with traumatic brain injury matched by age, gender, and admission functional status

Pace 2007

Statistical analysis

 Chi² test, Student t test (paired or not, as appropriate)

Results

At 3‐months follow‐up:

• BI improved in 47 participants (39%), was stable in 20 (16%), and worsened in 54 (44%).

• In those with clinical improvement, BI score increased significantly from baseline (median 15 points, P < 0.001).

• KPS scores were better in only 24% of participants by median 10 points (P < 0.001).

• No significant difference was observed between various subgroups of brain tumour and between those with initial diagnosis and those treated for reoccurrence.

• Only 54 participants completed the QoL questionnaire before and after treatment: 72% were found to have an improvement in at least one domain score compared with their baseline QoL scores.

• In those with improved BI scores, physical and social scores increased in 67%, emotional functional score increased in 39%, and global QoL score increased in 44%.

Author’s conclusion

Multidisciplinary rehabilitation at home in people with brain tumour was associated with significant functional gain measured both with BI and KPS. The benefit of multidisciplinary rehabilitation may influence patient's perception of quality of life

Sherer 1997

Statistical analysis

Descriptive analyses only

Results

• At the time of discharge from the programme, 6 participants had increased independence, 6 were unchanged, and 1 had decreased independence.

• At discharge, 8 participants had increased productivity (increased/improved/maintained the previous vocational status), 4 were unchanged, and 1 had decreased productivity.

• At 8‐months follow‐up after discharge all the treatment gains were maintained. At follow‐up, compared with admission status, 7 participants had increased independence, 4 were unchanged, 1 had decreased independence, and 1 had died.

Author’s conclusion

People with primary malignant brain tumours achieved increased community independence and vocational outcomes (such as employment, education) after individualised outpatient multidisciplinary rehabilitation. Such treatment programme appears to be an attractive, relatively low‐cost option for these patients, however additional investigation is needed.

Tang 2008

Statistical analysis

ANOVA, Chi² test, Kruskal‐Wallis and post‐hoc tests using Mann‐Whitney U test with Bonferroni adjustment, Wilcoxon signed‐ranks test, logistic regression, Kaplan‐Meier analyses

Results

• All groups made significant improvement in their FIM scores from admission to discharge. Motor FIM, but not cognitive FIM scores, improved significantly in all 3 groups.

• FIM efficiency was comparable between groups (0.33 GBM, 0.4 metastatic, 0.2 other).

• None of the independent variables (age, length of rehabilitation, concurrent radiation therapy, concurrent chemotherapy, type of tumour, hemispheric location, or number of brain lesions) were significant predictors of high or low FIM gain for all people with brain tumours.

• Discharge‐to‐home rate was comparable between groups (76% GBM, 72% metastatic, 70% other).

• Estimated median survival was 141 days for brain metastases, 214 days for GBM, and 439 days for other tumours.

Author’s conclusion

People with primary and metastatic brain tumours achieved functional gains after multidisciplinary rehabilitation. High functional improvement is a significant predictor of longer survival in brain metastases and GBM.