Can Multidisciplinary Inpatient and Outpatient Rehabilitation Provide Sufficient Prevention of Disability in Patients with a Brain Tumor?—A Case-Series Report of Two Programs and A Prospective, Observational Clinical Trial

Abstract

Brain tumor (BT) patients have a high incidence of disability due to the effects of the tumor itself or oncological treatment. Despite the incidence of neurological and functional deficits caused by BT, rehabilitation of those patients is not as properly established as in patients with other neurological conditions. The aim of the research was to evaluate the effectiveness of a multidisciplinary rehabilitation, carried out as an out- or in-patient program, as prevention of disability in BT patients. This was developed as a case-series report of two programs and a prospective, observational clinical study in BT patients who were allocated to inpatient (n = 28) or outpatient (n = 26) rehabilitation programs. The patients were assessed using the Barthel Index, Berg Balance Scale, Functional Independence Measure (FIM), Functional Assessment of Cancer Therapy—Brain and Cognitive Function, and Addenbrooke’s Cognitive Examination III (ACE III) upon admission and after 12 weeks of rehabilitation. Analysis of the results showed that patients in both programs significantly improved their physical functioning scores in daily activities (p < 0.0001). We also observed significant reductions in most post-intervention cognitive complaints (p < 0.05), except for the FIM social functioning and ACE III language functioning in the outpatient group (p > 0.05) in contrast to inpatients (p < 0.001). This is evidence that early multidisciplinary rehabilitation is an effective therapeutic strategy to reduce BT symptoms and disability in this group of patients.

A systematic review of cognitive interventions for adult patients with brain tumours

“…Like the studies evaluating pharmacological interventions, those evaluating nonpharmacological intervention included patients that had received varying treatments including surgery, radiotherapy and/or chemotherapy. Although many of the studies used a combination of several cognitive tests spanning multiple cognitive domains, some studies relied on the use of a single cognitive measure such as the MMSE, 39 Addenbrooke's Cognitive Examination III, 42 or Repeatable Battery for the Assessment of Neuropsychological Status (R‐BANS) 13 ; in the latter study, the R‐BANS was not completed by most patients at follow‐up, and thus, no longer‐term follow‐up data were provided. One study, published in abstract form, did not describe the specific cognitive tests used 11 .…”

“…Of the 21 nonpharmacological studies identified, 11 were randomised 11–15,18,19,21,37–39 and 10 were nonrandomised 16,17,20,22,40–45 . Most of the nonpharmacological studies evaluated cognitive training or rehabilitation programmes 11–18,22,38–41,43,44 .…”

“…The cognitive rehabilitation was delivered through a range of modalities, including computer programs and virtual reality. Other interventions studied include aerobic exercise, 19 hyperbaric oxygen, 20,37 ketogenic diet with intermittent fasting 21 and broad multidisciplinary rehabilitation 42,45 . Due to the nature of the nonpharmacological interventions, a placebo intervention was not described in studies.…”

“…20,22,40,41,43,45 Like the pharmacological intervention studies, loss to follow-up and study withdrawal was common in the included studies. Some of the included nonpharmacological studies recruited solely glioma patients, 11,12,14,19,21,41,43,44 and others included multiple pathologies including ependymoma, 37,42 subependymoma, 42 medulloblastoma, 37 neuroblastoma, 37 meningioma, 13,15,17,18,20,22,38,39,42 craniopharyngioma, 40 metastasis 17,20,39 and non-Hodgkin lymphoma. 20 Like the studies evaluating pharmacological interventions, those evaluating nonpharmacological intervention included patients that had received varying treatments including surgery, radiotherapy and/or chemotherapy.…”

Rehabilitation Nursing for Brain Tumor Patients: A Scoping Review

“…Additionally, in four articles, setting goals with patients based on information collected from patients and families were addressed. [28][29][30][31] Particularly, Andrejeva and Volkova emphasized the importance of understanding patient needs when setting appropriate goals. 29 These aspects involved the process of organizing information based on collected data, hence categorized under information gathering and organization.…”