Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: A controlled clinical trial
Fary Khan, Bhasker Amatya, Kate Drummond, Mary Galea
Department of Rehabilitation Medicine, Royal, Melbourne Hospital, 34-54 Poplar Road, Parkville, Melbourne VIC 3052, Australia. E-mail: email@example.com
Objective: To evaluate effectiveness of a multidisciplinary rehabilitation program for persons following definitive primary brain tumour treatment in a community cohort.
Methods: The brain tumour (glioma) survivors (n = 106) were allocated either to the treatment group (n = 53) (intensive ambulatory multidisciplinary rehabilitation), or the waitlist control group (n = 53). The primary outcome – Functional Independence Measure (FIM), measured ‘Activity’ limitation; secondary measures included Depression, Anxiety Stress Scale, Perceived Impact Problem Profile and Cancer Rehabilitation Evaluation System. Assessments were at baseline, 3 and 6 months after program completion.
Results: Participants were predominantly women (56%), with mean age 51 years (standard deviation 13.6) and median
time since diagnosis of 2.1 years. Intention-to-treat analysis showed a significant difference between groups at 3-month in favour of multidisciplinary rehabilitation program in FIM motor subscales: ‘self-care’, ‘sphincter’, ‘locomotion’, ‘mobility’(p < 0.01 for all); and FIM ‘communication’ (p < 0.01) and ‘psychosocial’ subscales (p < 0.05), with small to moderate effect size (r = 0.2–0.4). At 6-month follow-up, significant improvement in the treatment group was maintained only for FIM ‘sphincter’, ‘communication’ and ‘cognition’ subscales (p < 0.01 for all). No difference between groups was noted in other subscales.
Conclusions: brain tumour survivors can improve function with multidisciplinary rehabilitation, with some gains maintained up to 6 months. Evidence for specific interventions in the ‘blackbox’ of rehabilitation is needed.
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