Articles
Functional outcomes of persons with brain tumors after inpatient rehabilitation,☆☆

https://doi.org/10.1053/apmr.2001.21862Get rights and content

Abstract

ABSTRACT.Marciniak CM, Sliwa JA, Heinemann AW, Semik PE. Functional outcomes of persons with brain tumors after inpatient rehabilitation. Arch Phys Med Rehabil 2001;82:457-63. Objective: To assess the extent of functional gains measured before and after inpatient rehabilitation in patients who have primary or metastatic brain tumors, and to identify whether the tumor type, recurrent tumor, or ongoing radiation influences outcomes. Design: Retrospective, descriptive study. Setting: A free-standing university-affiliated rehabilitation hospital. Participants: A referred sample of 132 persons, all with functional impairments from a brain tumor and discharged from inpatient rehabilitation during a 3-year time period. Intervention: Comprehensive inpatient rehabilitation. Main Outcome Measures: Functional status and rate of functional improvement (gain) as measured by the FIM™ instrument and FIM efficiency. Results: Mean FIM efficiencies ± standard deviation for motor (.82 ±.69) and cognitive (.15 ±.24) functions were equivalent across primary and metastatic tumor types (F =.42, df = 3,103, p = NS; F =.45, df = 2,104, p = NS, respectively); patients with metastatic disease had a significantly shorter length of stay at 18 ± 12.3 days (t30,6 = 2.3, p =.03). Patients who received radiation during rehabilitation had a significantly greater (F = 4.1, df = 1,105, p <.05) motor efficiency score (1 ±.79) than those who did not (.78 ± 0.7). Patients with recurrent tumors made FIM cognitive changes equivalent to those of persons undergoing rehabilitation after their initial diagnosis, but their motor efficiency scores were significantly smaller (.55 ±.39 vs.98 ±.68, respectively) (F = 5.77, df = 1,85, p =.018), which reflected a significantly smaller FIM motor change. Conclusions: Metastatic or primary brain tumor type does not affect the efficiency of functional improvement during inpatient rehabilitation. Patients receiving concurrent radiation therapy make greater functional improvement per day than those not receiving radiation. Patients with recurrent tumors make significantly smaller functional motor gains than those completing inpatient rehabilitation after the tumor's initial diagnosis. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

We reviewed the charts of all patients diagnosed with a primary or secondary brain tumor who were at or over the age of 18 years and were discharged from our comprehensive, free-standing, university-affiliated, inpatient acute rehabilitation program within a 3-year period (Sept 1993-Aug 1996). Through program outcome data and chart review we obtained: (1) demographic data including age, gender, inpatient rehabilitation length of stay (LOS), and discharge location; (2) tumor information,

Results

A total of 120 charts representing 132 patient admissions that fulfilled the inclusion criteria were reviewed. Nine people were admitted for more than 1 rehabilitation stay; both first and subsequent rehabilitation admissions were included in the study. Two charts were not available and only data from program evaluation could be used in these cases. The 23 admissions who did not have complete admission and discharge FIM data were excluded from analyses of FIM change and efficiency.

Of our total

Discussion

Brain tumors, both primary and metastatic, are increasing in frequency.11 This increase is being seen in an older population with malignant brain tumors as well as in nonimmunosuppressed individuals with lymphomas.11 Metastatic disease to the brain has also become more prevalent as treatments have improved for tumors of nonneurologic origin.11 Newer chemotherapeutic agents, such as implantable chemotherapy wafers, and more aggressive radiation treatments, including gamma knife, external beam

Conclusion

Persons with brain tumors hospitalized for inpatient rehabilitation have significant functional impairments that can improve with inpatient rehabilitation interventions. Even patients with more histologically aggressive tumor types improved their FIM scores after an inpatient rehabilitation program and radiation did not impact negatively on the gains made. Decisions regarding the provision of inpatient rehabilitation should not be based solely on the tumor type or requirements for ongoing

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    ☆☆

    Reprint requests to Christina M. Marciniak, MD, Rehabilitation Institute of Chicago, Rm 1106, 345 E Superior St, Chicago, IL 60611.

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