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Fu JB, Morishita S. Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility. Am J Phys Med Rehabil 2024; 103:S46-S51. [PMID: 38364030 PMCID: PMC10878715 DOI: 10.1097/phm.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Hematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitation experience a high rate of transfer to the primary acute service and high rate of mortality after transfer back. Physical medicine and rehabilitation physicians can use a number of strategies to mitigate these patients' risk of medical complications including evidence-based predictive models to assist with postacute rehabilitation triage, physiatry-led consult-based rehabilitation, and oncology hospitalist comanagement on inpatient rehabilitation.
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Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, Section of Physical Medicine & Rehabilitation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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Magrelli A, Scannavini P, D'Angelo D, Latini CM, Felli S, Di Nitto M, Russo G, Mastroianni C, Navalesi G, Casale G. Cultural Adaptation and Testing of the Italian Version of the Edmonton Functional Assessment Tool-2 (EFAT2-I). J Palliat Care 2024; 39:29-35. [PMID: 34967256 DOI: 10.1177/08258597211059304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physiotherapy in Palliative Care (PC) is effective in the management of a series of respiratory, circulatory and motor symptoms, and often has a positive impact on the patient's mood. The Edmonton Functional Assessment Tool (EFAT) is the only existing validated tool specifically designed for functional assessment in PC, and its use has been recommended in clinical practice. To date, no Italian version of the tool has been validated. The aim of this study was to translate, cross-culturally adapt, and evaluate the psychometric properties of the Italian version of the EFAT2. METHOD After receiving formal permission from the author, Beaton guidelines for cross-cultural adaptation were followed, namely: (1) forward translation; (2) a multidisciplinary focus group (including 4 physiotherapists, 1 physician, 3 nurses, 1 occupational therapist, 1 psychologist) to assess semantic, idiomatic, experiential, and conceptual equivalence; (3) backward translation. The Content Validity Index (CVI) was used to assess content validity of the tool. Construct and concurrent validity were also evaluated. To evaluate the reliability of the EFAT2-I, reliability was measured using Cronbach alfa, item-total correlation, and Cohen's Kappa. RESULTS 119 patients admitted to a Palliative Care Unit (Italy) agreed to participate in the study. The EFAT2-I mean score was 11.3, ranging from 0 to 30. Very good CVI scores were achieved, both in terms of single item validity (I-CVI) and of whole scale validity (S-CVI). Positive results were obtained from construct, concurrent validity assessment and measures of reliability. DISCUSSION The EFAT2-I showed good psychometric properties and can be used as a rehabilitation assessment tool in palliative care settings. The validation of the Italian version will allow comparison of different centres and palliative care facilities on national and international levels.
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Affiliation(s)
| | | | - Daniela D'Angelo
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | - Giuseppina Russo
- Provincia della Natività B.M.V. - O.SS.T., Gagliano del Capo, Italy
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Shimoda K, Imai H, Tsuji T, Tsuchiya K, Tajima H, Kanemaki H, Tozato F. Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study. J Phys Ther Sci 2019; 31:795-801. [PMID: 31645809 PMCID: PMC6801346 DOI: 10.1589/jpts.31.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
[Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer
is futile. We determined factors affecting the performance of activities of daily living
in patients with advanced cancer based on age, gender, marital status, living arrangement,
rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer
treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the
performance of activities of daily living. Of the 120 adult patients with cancer who
underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10
items, and reviewed the clinical characteristics from the medical records of 48 patients
who completed supportive or palliative rehabilitation according to Dietz and showed an
increased or maintained total Barthel Index score at final evaluation. [Results] The
median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the
rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that
the increase of total Barthel Index score was positively associated with rehabilitation
intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277).
[Conclusion] Adequate rehabilitation positively affects performance of activities of daily
living, especially in patients with advanced cancer who lost their grooming ability at the
onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with
advanced cancer.
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Affiliation(s)
- Kaori Shimoda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hiroshi Tajima
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
| | - Hatsumi Kanemaki
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
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Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Tanaka A, Takazawa A, Yoshida K, Ido Y, Ishida T, Kawasaki K, Kato H. Using the Barthel Index to Assess Activities of Daily Living after Musculoskeletal Tumour Surgery: A Single-centre Observational Study. Prog Rehabil Med 2019; 4:20190010. [PMID: 32789257 DOI: 10.2490/prm.20190010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of the current study was to find the factors affecting the activities of daily living, as evaluated by the Barthel Index, at the end of rehabilitation after musculoskeletal tumour surgery. Further, we evaluated whether the Barthel Index correlates with functional scores that are specific to musculoskeletal tumours at final follow-up. Methods The activities of daily living of 190 patients who underwent postoperative rehabilitation after surgery to treat musculoskeletal tumours were evaluated at the end of the program using the Barthel Index. Functional evaluation at the time of final follow-up observation was evaluated using the Musculoskeletal Tumour Society Score and the Toronto Extremity Salvage Score. Results The post-rehabilitation Barthel Index was significantly lower in elderly patients aged more than 60 years and in those with malignant tumours and tumours larger than 10 cm. Malignancy and large tumour size were risk factors for a low Barthel Index. There was significant correlation between the Musculoskeletal Tumour Society Score/Toronto Extremity Salvage Score at final functional evaluation and the Barthel Index at the end of rehabilitation. Conclusion The Barthel Index is a simple method to assess the activities of daily living and can potentially predict disease-specific health-related quality of life at final functional evaluation after musculoskeletal tumour surgery.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuo Yoshimura
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaoru Aoki
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazushige Yoshida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshikazu Ido
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takaaki Ishida
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiko Kawasaki
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Javier NM, Montagnini M. The Role of Palliative Rehabilitation in Serious Illness #364. J Palliat Med 2018. [DOI: 10.1089/jpm.2018.0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Integrating Function-Directed Treatments into Palliative Care. PM R 2017; 9:S335-S346. [DOI: 10.1016/j.pmrj.2017.07.073] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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Guo Y, Fu JB, Guo H, Camp J, Shin KY, Tu SM, Palmer LJ, Yadav R. Postacute Care in Cancer Rehabilitation. Phys Med Rehabil Clin N Am 2017; 28:19-34. [DOI: 10.1016/j.pmr.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Uhm KE, Yoon TH, Hwang JH. Clinical characteristics and rehabilitation of hospitalised cancer patients in a Korean tertiary hospital. Singapore Med J 2016; 58:502-507. [PMID: 27029806 DOI: 10.11622/smedj.2016064] [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: 11/18/2022]
Abstract
INTRODUCTION With the increase in the patient survival rates of many types of cancers, a greater proportion of cancer patients live with disease-related problems that diminish their quality of life. This study aimed to investigate the clinical characteristics and rehabilitation of hospitalised cancer patients who were referred to the Department of Physical and Rehabilitation Medicine (PRM) at Samsung Medical Center, a tertiary university hospital in Seoul, Korea. METHODS Hospitalised cancer patients aged > 18 years who were referred to the Department of PRM from January to December 2012 were enrolled in this retrospective study. We reviewed the clinical characteristics of the patients, the principal reasons for their referral and relevant details of their rehabilitative management. RESULTS A total of 1,340 cases were included. The most common primary cancer was lung cancer (19.0%) and 28.6% of the cases had solid organ metastasis. The most common reason for referral was deconditioning (31.7%), followed by weakness (23.1%) and respiratory problems (14.5%). Bedside exercise was prescribed to 28.4% of the patients, exercise in the rehabilitation therapy unit to 28.0% and pulmonary rehabilitation to 14.3%. Among the 1,340 cases, 107 (8.0%) were transferred to the Department of PRM for comprehensive rehabilitation. The 32 patients with an identifiable Modified Barthel Index score showed significant functional improvement. CONCLUSION The findings of the present study contribute to a better understanding of rehabilitation for hospitalised cancer patients. The information obtained will also be helpful in the development of appropriate cancer rehabilitation strategies.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Tae Hee Yoon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Rajendran V, Jeevanantham D. Assessment of physical function in geriatric oncology based on International Classification of Functioning, Disability and Health (ICF) framework. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer 2015; 23:2447-60. [PMID: 25971213 DOI: 10.1007/s00520-015-2744-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/20/2015] [Indexed: 02/07/2023]
Abstract
The purpose of this paper is to review the evidence for the role of physical rehabilitation in stem cell transplantation patients. We will also review the literature and discuss professional experiences on how rehabilitation can play a role in stem cell transplant care and survivorship. Hematopoietic stem cell transplantation (HCT) is a procedure that has evolved substantially over the years to help treat multiple conditions, particularly hematologic malignancies. HCT can be very stressful on the body and can leave patients weakened and sometimes quite debilitated. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. One key component of improved supportive care is gaining increased attention, and that is physical medicine and rehabilitation. Its role in HCT survivorship care is expanding, and new insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal sequelae of transplantation. This literature review has demonstrated the utility of physical rehabilitation in HCT, its impact on cancer-related fatigue, and to outline the current state of the literature on these topics. The paper delves into a background of HCT. Cancer-related fatigue in HCT is then discussed and summarized, and the role that exercise plays in modifying such fatigue is outlined. We then outline the models and the impact that physical rehabilitation may play in HCT recipients.
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Yang EJ, Chung SH, Jeon JY, Seo KS, Shin HI, Hwang JH, Lim JY. Current Practice and Barriers in Cancer Rehabilitation: Perspectives of Korean Physiatrists. Cancer Res Treat 2015; 47:370-8. [PMID: 25672583 PMCID: PMC4506115 DOI: 10.4143/crt.2014.084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess clinical practice and barriers associated with cancer rehabilitation from the perspective of Korean physiatrists. Materials and Methods All active members of the Korean Academy of Rehabilitation Medicine were invited to complete an online survey developed after focus group discussions. Results A total of 97 physiatrists (72 males and 25 females) in Korea completed the survey. Of these, 77% reported familiarity with the term 'cancer survivors.' More than 50% of respondents reported that they provided rehabilitation services for patients with breast cancer (61.9%), brain tumors (64.9%), and spinal tumors (63.9%), whereas 86.6% of respondents reported that they had never or rarely provided rehabilitation programs for patients with gynecological, colorectal, or prostate cancer. Physiatrists who received referrals from a well-organized cooperative referral system reported providing services such as exercise programs for patients with gynecological cancer (odds ratio [OR], 2.16; p=0.044) as well as education regarding lymphedema (OR, 1.81; p=0.047) and neuropathic pain (OR, 1.96; p=0.026). Conclusion Although most of the physiatrists surveyed believed that they should contribute to the management of cancer patients, they considered themselves ill equipped to provide appropriate rehabilitation services. This lack of understanding of the effectiveness of rehabilitation services for cancer patients and absence of a cooperative referral system are the major barriers to providing rehabilitation services to cancer survivors in Korea.
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Affiliation(s)
- Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
| | - Seung Hyun Chung
- Department of Physical Medicine and Rehabilitation, National Cancer Center, Goyang, Korea
| | - Jae-Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
| | - Ji Hye Hwang
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
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Eyigor S, Akdeniz S. Is exercise ignored in palliative cancer patients? World J Clin Oncol 2014; 5:554-559. [PMID: 25114869 PMCID: PMC4127625 DOI: 10.5306/wjco.v5.i3.554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/17/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Exercise and rehabilitation approaches in palliative care programs for cancer patients affect patients’ symptoms, physical functioning, muscle strength, emotional wellbeing, psychological symptoms, functional capacities, quality of life, mortality and morbidity positively. Based on scientific data, palliative cancer patients should be recommended to participate in exercise programs. There is no standard approach to recipe an exercise regimen for a palliative cancer survivor. Studies for demonstrating the positive effects of exercising in palliative care patients are increasing in number day by day. At this point, increasing awareness about exercising in the entire team monitoring the patient and our efforts in this matter seems to be very important.
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Sekine R, Ogata M, Uchiyama I, Miyakoshi K, Uruma M, Miyashita M, Morita T. Changes in and Associations Among Functional Status and Perceived Quality of Life of Patients With Metastatic/Locally Advanced Cancer Receiving Rehabilitation for General Disability. Am J Hosp Palliat Care 2014; 32:695-702. [PMID: 24907122 DOI: 10.1177/1049909114537871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status.
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Affiliation(s)
- Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Masami Ogata
- Department of Rehabilitation Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ikuyo Uchiyama
- Department of Rehabilitation Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Koichi Miyakoshi
- Department of Rehabilitation Medicine, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Megumi Uruma
- Department of Rehabilitation Medicine, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Gardiner A, Samuel D. Evaluation of the Edmonton Functional Assessment Tool (EFAT2) within palliative care: a pilot study. Aging Clin Exp Res 2014; 26:293-8. [PMID: 24318746 DOI: 10.1007/s40520-013-0174-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/20/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing need for rehabilitation in both cancer and palliative care. However, there are few validated outcome measures that are suitable for measuring functional performance in this population. The present study evaluated the validity, sensitivity and reliability of the Edmonton Functional Assessment Tool (EFAT2) within a UK palliative care setting. METHODS Eleven participants aged 65 years and over (mean age 76.5 ± 6.7 years) receiving rehabilitation in a palliative care inpatient setting were studied. Concurrent validity was assessed by comparing EFAT2 with the Barthel Index. Inter-rater reliability of EFAT2 was examined using a sample of four participants recruited from a cancer care ward. RESULTS A significant negative correlation was observed between the Barthel Index and EFAT2 (r = -0.765, p = 0.01) and both measures were found to be sensitive as determined by Cohen's effect size (EFAT2 = 0.60, Barthel Index = 0.72). High inter-rater reliability was noted for EFAT2 (ICC3, 1 = 0.85) and the agreement between scores was confirmed by Bland-Altman analysis. CONCLUSIONS EFAT2 showed concurrent validity with the Barthel Index when used to assess the effects of rehabilitation on participants with advanced cancer. The tool was sensitive to change and was found to be reliable when used by different raters. The findings indicate that EFAT2 might be an appropriate outcome measure to use within the palliative care setting. However, the feasibility of using EFAT2 needs to be explored and larger studies are required to confirm its reliability.
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Affiliation(s)
- A Gardiner
- Faculty of Health Sciences, University of Southampton, Building 45, Burgess Road, Highfield, Southampton, SO17 1BJ, UK
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Lin HF, Wu YT, Tsauo JY. Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database. BMC Health Serv Res 2012; 12:255. [PMID: 22898402 PMCID: PMC3465188 DOI: 10.1186/1472-6963-12-255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 08/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. METHODS Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. RESULTS The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). CONCLUSIONS In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.
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Affiliation(s)
- Heui-Fen Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Javier NSC, Montagnini ML. Rehabilitation of the hospice and palliative care patient. J Palliat Med 2011; 14:638-48. [PMID: 21592031 DOI: 10.1089/jpm.2010.0125] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Disability is a common problem among hospice and palliative care patients. It leads to depression, poor quality of life, increased caregiver needs, health care resource utilization, and need for institutionalization. There is a growing body of evidence that rehabilitation interventions improve functional status, quality of life, and symptoms such as pain and anxiety in this population. Having adequate knowledge about rehabilitation is essential for the provision of comprehensive end-of-life care. The goals of this article are to review the role and benefits of rehabilitation in hospice and palliative care; to discuss the elements of patient assessment for rehabilitation including the use of functional assessment tools; and to review the roles of physical, occupational, and speech therapy in hospice and palliative care patients.
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Affiliation(s)
- Noel S C Javier
- Division of Geriatrics, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Gamble GL, Gerber LH, Spill GR, Paul KL. The Future of Cancer Rehabilitation. Am J Phys Med Rehabil 2011; 90:S76-87. [DOI: 10.1097/phm.0b013e31820be0d1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Schleinich MA, Warren S, Nekolaichuk C, Kaasa T, Watanabe S. Palliative care rehabilitation survey: a pilot study of patients' priorities for rehabilitation goals. Palliat Med 2008; 22:822-30. [PMID: 18772213 DOI: 10.1177/0269216308096526] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rehabilitation in palliative care is often overlooked. Settings that do consider occupational or physical therapy for palliative care patients often consult to therapists with competing caseloads. Few therapists specialise in palliative care, but nearly all ask, 'What needs doing'? and 'How well am I doing that'? No existing instruments address their questions. The objective is to develop and test a questionnaire for identifying patient goals and priorities for rehabilitation in palliative care. A questionnaire representing 11 domains of the Canadian Model of Occupational Performance was designed and pilot tested at four palliative care sites. Each question reflected a typical rehabilitation intervention in palliative care. Patients were asked to rate how important each of these interventions was on a numerical rating scale (0, not important-10, extremely important). Open-ended questions captured verbatim comments regarding thoughts of rehabilitation. The questionnaire was tested for test-retest reliability with two interviews approximately 1 week apart. Forty patients participated in the first interview and 32 in the second. Eight of eleven domain sub-scores achieved an intra-class correlation coefficient of 0.6 or higher. The highest means were for the physical (8.2), institutional (7.8) and self-care (7.8) domains on the first interview and for the spiritual domain (7.9) on the second interview. Suggestions are provided to shorten the questionnaire and strengthen validity. This work furthers the understanding of the role of rehabilitation in palliative care. It also illustrates the feasibility of involving palliative care patients in research that contributes to setting standards and measuring quality of service.
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Affiliation(s)
- M A Schleinich
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.
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Affiliation(s)
- Mary M. Vargo
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH
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Abstract
Impairments and disability in cancer patients can be caused by the disease process or by its treatment, including the effects of surgery, chemotherapy, and radiation. The prevalence of all cancers, with an estimated 1.4 million new cases in 2006, the development of new treatment options, and improved outcomes have created a constantly growing population of cancer survivors whose function and quality of life have been affected by their diagnoses. This article reviews the theoretical framework, clinical interventions, and research initiatives pertinent to providing rehabilitation services for patients who have been diagnosed with cancer.
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Thomas J. Optimizing Opioid Management in Palliative Care. J Palliat Med 2007; 10 Suppl 1:S1-18; quiz S19-23. [DOI: 10.1089/jpm.2007.9828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Jay Thomas
- San Diego Hospice and Palliative Care, Department of Medicine, University of California–San Diego, San Diego, California
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Abstract
BACKGROUND Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function. OBJECTIVE The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS. METHODS We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment. RESULTS Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings. CONCLUSION The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.
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Affiliation(s)
- Salvatore J Scialla
- Hematology and Oncology Associates of Northeastern PA, Dunmore, Pennsylvania 18512, USA.
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Guo Y, Palmer JL, Kaur G, Hainley S, Young B, Bruera E. Nutritional status of cancer patients and its relationship to function in an inpatient rehabilitation setting. Support Care Cancer 2004; 13:169-75. [PMID: 15580364 DOI: 10.1007/s00520-004-0680-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Accepted: 07/27/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Malnutrition is associated with prolonged hospitalization, lower survival rate, and various medical complications. However, little is known about malnutrition and its relationship with the functional status. We undertook this retrospective study to examine whether or not malnutrition affects rehabilitation outcome in patients who had undergone cancer rehabilitation. METHODS We conducted a review of the charts of 30 consecutive cancer patients who had been admitted to the inpatient rehabilitation unit in a tertiary cancer center, from the beginning of March 2001 to the end of April 2001. RESULTS The patients' mean rehabilitation stay was 9 days and their mean age was 58 years (range 22-86 years). On rehabilitation admission, 15 of the patients (50%) had a below normal prealbumin (<18 mg/dl) level (95% confidence interval 31-69%), and on discharge 10 of the patients (33%) had a below normal prealbumin level (95% CI 17-54%). The serum prealbumin concentration level correlated with motor functional independence measure scores on admission. After inpatient rehabilitation, statistically significant gains in functional independence measure scores (P<0.0001) were obtained in patients with below normal admission prealbumin, as well as in those whose prealbumin levels were within the normal range; no statistically significant difference was found in functional gain between these two groups. CONCLUSION Our study showed that a large number of cancer rehabilitation patients had malnutrition. Nevertheless, functional gain was achieved in all patients after rehabilitation, whether or not malnutrition was present. We conclude that malnourished patients should still be considered candidates for rehabilitation.
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Affiliation(s)
- Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Older persons with cancer can often benefit from rehabilitative care. Rehabilitation may be of benefit to the patient whether or not their malignancy is curable. Rehabilitative programs must be tailored to the patient's abilities, endurance, prognosis, and individual goals.
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Affiliation(s)
- Neil J Nusbaum
- Department of Medicine, University of Medicine College of Medicine at Rockford, IL 61107, USA.
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Movsas SB, Chang VT, Tunkel RS, Shah VV, Ryan LS, Millis SR. Rehabilitation needs of an inpatient medical oncology unit11No 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. Arch Phys Med Rehabil 2003; 84:1642-6. [PMID: 14639564 DOI: 10.1053/s0003-9993(03)00345-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify prospectively functional impairments and rehabilitation needs in an acute care medical oncology unit. DESIGN Prospective cohort study. SETTING Inpatient medical oncology unit at a Veterans Affairs hospital. PARTICIPANTS Fifty-five patients admitted over a 6-month period. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM instrument, functionally based physical examination, Rehabilitation Needs Assessment, and Recreational Needs Assessment. RESULTS On admission, the mean FIM total score was 105 out of 126, the FIM motor score was 72 out of 91, and the FIM cognitive score was 34 out of 35. The functionally based physical examination did not generally correlate with scores obtained on the FIM. Forty-eight (87%) patients had rehabilitation needs on admission. Forty-six (84%) patients had rehabilitation needs on discharge. Rehabilitation Needs Assessment on admission showed deconditioning in 42 (76%) patients; mobility impairment in 32 (58%) patients; a significant decrease in range of motion in 23 (42%) patients; deficits in activities of daily living in 12 (22%) patients; a need for recreational therapy in 7 (13%) patients; potential for benefit from patient education in 30 (55%) patients; and a need for modalities, edema control, or wound care in fever than 5% of patients. The most commonly requested recreational activity was reading. CONCLUSIONS Patients admitted to inpatient medical oncology units have many unmet, remediable rehabilitation needs that may not be recognized by nonrehabilitation physicians and other clinical staff. These findings suggest that assessment of medical oncology patients may be enhanced by consultation with rehabilitation medicine specialists.
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Affiliation(s)
- Sheryl B Movsas
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
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Abstract
Cancer is a significant cause of physical and cognitive disability. The concept of cancer rehabilitation was developed in the 1970s; it was a concept that led to funding support and to significant contributions to symptom management. A recent trend has been an increase in the number of cancer diagnoses and an increase in cancer survival rate. This suggests that more persons with cancer are living longer despite cancer-caused impairments. Interdisciplinary cancer rehabilitation programs are designed to help cancer patients achieve maximal functional ability and adapt to disabilities resulting from cancer or its treatments. Currently, there are few cancer rehabilitation programs in the United States. Information about the role of rehabilitation nursing in cancer patient care is scarce. The purposes of this article were to review the history of cancer rehabilitation; review functional outcomes that have been reported in current research; and identify the multiple, complex challenges that illustrate the role of a cancer rehabilitation clinical nurse specialist in the rehabilitation of cancer patients.
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Affiliation(s)
- Lisa A Beck
- Mayo Clinic, Rochester Methodist Hospital, 201 West Center Street, Rochester, MN 55902, USA.
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Abstract
BACKGROUND In the supportive oncology and palliative care settings, rehabilitation interventions are often overlooked and underutilized, despite high levels of functional disability in these patients. As a result, little is known about the utilization or effectiveness of rehabilitation interventions in palliative care populations. OBJECTIVE To assess the utilization of physical therapy (PT) in a hospital-based palliative care unit, to characterize functional disabilities in patients who received PT, and to identify factors related to functional improvement following a course of PT. METHODS Retrospective chart review of 100 patients (mean age 70 years, 97% male) discharged from the Milwaukee Veterans Hospital Palliative Care unit over 15 months. Activities of daily living (ADL) performance scores were recorded on admission, at 2 weeks, and at completion of the PT program and correlated with demographic and disease-related variables. RESULTS Thirty-seven patients received a formal PT assessment, and 18 patients underwent PT. The most common functional disabilities in patients who received PT were deconditioning, pain, imbalance, and focal weakness. Ten patients demonstrated improvement in ADL function at 2 weeks. Six patients completed the course of PT. Albumin was significantly correlated with functional improvement. When controlling for albumin, patients with diagnosis of dementia were more likely to show improvement in functional status than patients without a dementia diagnosis. CONCLUSION PT assessment and utilization were uncommon in this group. When utilized, PT benefited 56% of patients. Factors related to functional improvement following a PT course were a higher albumin level and a diagnosis of dementia. Prospective trials of PT in palliative care patients are needed to better define response rate and predictors of response.
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Affiliation(s)
- Marcos Montagnini
- Division of Geriatrics and Gerontology, Department of Internal Medicine, The Medical College of Wisconsin Milwaukee, Wisconsin, USA.
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Abstract
Evaluation of functional status plays a unique role in the assessment of older cancer patients. While performance status has been the traditional method for oncologists to assess the impact of a cancer patient's disease, older cancer patients may require a more thorough evaluation of their functional status. Evaluation of functional status provides information that can predict outcomes and may provide information that can be utilized to improve function. Functional status evaluation can be useful throughout the patient's illness, at the initial diagnostic evaluation, for determining appropriate therapies, for the monitoring of therapeutic effect and finally in the palliative phase. There are many different methods available to assess functional status. Individual assessment of functional status in the context of a geriatric assessment may be an important component of the care older cancer patients receive.
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Affiliation(s)
- Katherine S Garman
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Box 2885, Durham, NC 27710, USA.
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Abstract
People with cancer often have functional limitations resulting from fatigue, deconditioning, pain, or metastasis to the musculoskeletal or nervous system, in addition to the psychosocial aspects of dealing with their disease. Their medical caregivers often focus on treating the disease and overlook these important aspects. The Department of Physical Medicine and Rehabilitation at the Mayo Clinic developed a Cancer Rehabilitation Service in 1979 to address these needs for hospitalized patients. Some of the challenges and successes of this service are briefly discussed in this article.
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Affiliation(s)
- K D Schmidt
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
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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. [PMID: 11295004 DOI: 10.1053/apmr.2001.21862] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- C M Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
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Scialla S, Cole R, Scialla T, Bednarz L, Scheerer J. Rehabilitation for elderly patients with cancer asthenia: making a transition to palliative care. Palliat Med 2000; 14:121-7. [PMID: 10829146 DOI: 10.1191/026921600666299204] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The transition from curative to palliative care for elderly patients with cancer-related asthenia presents complex challenges to oncologists. A result of this complexity is a lack of regard for the maintenance of physical and mental function. This study examined the effects of comprehensive, multidisciplinary, inpatient rehabilitation on the physical and mental function of elderly cancer patients with asthenia. We found that both physical and mental function improved following inpatient rehabilitation. However, it is difficult to predict which patients benefit most from rehabilitation. Nevertheless, functional improvement following rehabilitation may allow medical caregivers to better distribute the type and intensity of care, and reduce the caregiver burden experienced by family members in the home.
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Affiliation(s)
- S Scialla
- Allied Services Rehabilitation Hospital, Scranton, PA
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