Evaluation and model of rehabilitation for primary malignant bone sarcoma patients after limb salvage

Abstract

Background and aims It has long been suspected that the rehabilitation available to patients with primary malignant bone sarcoma (PMBS) is not always adequate and appropriate to their needs. The National Specialised Commissioning Group (NSCG) commissioned the 2012–2013 Quality Improvement Development and Innovation Scheme (QIDIS) project (rehabilitation programme) to review the current rehabilitation services available to the PMBS patient groups at all five bone sarcoma specialist centres in England. Methods The 220 participating PMBS patients were provided with questionnaires, and clinicians at the participating centres were interviewed face-to-face. Patients were analysed in groups: upper limb and lower limb, and in the subgroups major and minor surgery. The groups were compared according to their preferences for rehabilitation interventions, the additional rehabilitation post-surgery that they felt was or would have been beneficial, and by their Toronto Extremity Salvage Scores (TESS). Results Out of the 220 questionnaires provided, 136 questionnaires were returned (a 62% response rate). This study identified the lack of the following factors to be associated with PMBS patients' rehabilitation and functional outcomes: equitable access to rehabilitation treatments; suitable rehabilitation admission; allied health professional (AHP) clinical progress reviews; a reliable and equitable referral system with robust referral criteria; a rehabilitation case coordinator; a nationally accepted functional outcome measure; and patients' involvement in the management of their rehabilitation to achieve the best possible outcome. Conclusions This study identified gaps in the current rehabilitation services for PMBS patients and makes several recommendations. The authors designed a postoperative model of rehabilitation, which identifies a number of target areas that may improve current rehabilitation services and enable rehabilitation professionals to assess a PMBS patient's needs to identify the most suitable rehabilitation programme for them.

Occupational therapy rehabilitation for sarcoma patients following limb salvage surgery: a scoping review

“…Of the 17 papers included in the review 3 were literature reviews [8,14,17], 1 was a mixed method study [22], 6 were retrospective cohort studies [23][24][25][26][27][28], 1 was a case control study [29], 4 were cross sectional studies [7,15,30,31], 2 qualitative studies [32,33]. Study populations were heterogenic and 3 studies included patients with a variety of cancers including sarcoma [22,26,28], 1 with both primary bone and soft tissue sarcomas [30], 7 with 100% soft tissue sarcoma patients [7,8,14,17,24,27,29] and 6 studies with 100% primary bone sarcoma patients [15,23,25,[31][32][33]. The age of study populations also varied with 5 studies reporting the results of adolescents and adults under the age of 35 years.…”

“…A standardised post-operative protocol focusing on mobility and transfers resulted in improved functional outcome scores in those with primary bone sarcoma [25]. However, the importance of individualised patient centred goals has also been acknowledged based on changes in functional outcome and was particularly beneficial for adolescents and young adults [15,22]. Furthermore patients who have a good understanding of their prognosis were found to be better able to set rehabilitation goals [28].…”

“…The International Classification of Functioning Disability and Health model [13] may be a useful tool for evaluating and formulating rehabilitation treatments and plans that acknowledge a combination of assessments and outcome measures for soft tissue sarcoma patients [8]. Hudson et al [15] proposed a model for post-operative rehabilitation of bone sarcoma patients to maximise outcome and patient satisfaction. It involves telephone consultations and clinical review at 6 weeks post-surgery, rehabilitation admissions at 3 and 9 months and a wellbeing day on completion of treatment.…”

“…It has been recognised that the rehabilitation burden can be greater for patients following limb salvage surgery than following limb amputation [14]. Following limb salvage surgery patients may experience difficulties resuming activities of daily living, participating in home and community activities and returning to work [15]. However, the aim is to enable them to regain their pre-operative functional levels.…”

“…It makes recommendations for the rehabilitation of people with cancer, placing importance on cancer survivorship and the role of allied health professionals. The Quality Improvement Development and Innovation Scheme project 2012-2013, commissioned by the National Sarcoma Commissioning Group, reviewed rehabilitation services for people with bone sarcoma and developed a model to provide effective and seamless rehabilitation across the UK [15]. Despite this work, guidelines to support occupational therapy practice with sarcoma patients are lacking.…”