Functional outcome and survival in spinal cord injury secondary to neoplasia

Murray, Patrick

doi:10.1002/1097-0142(19850101)55:1<197::aid-cncr2820550131>3.0.co;2-f

Cited by 42 publications

(18 citation statements)

References 11 publications

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“…Earlier studies endorse this functional gain. 10,[16][17][18][19] The discharge destination differed between the two groups studied. Patients who survived 41 year after in-patient rehabilitation were discharged to their home more often than patients who survived o1 year (82% versus 64%).…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The thoracic spine is most commonly affected, followed by the lumbar spine and the cervical spine. 7,10 The mean survival of patients with neoplastic spinal cord compression (SCC) after developing neurological signs is between 3 and 9 months. [11][12][13][14] Although it has been estimated that over 80% of patients with neoplastic SCC survive no longer than 1 year, a select group of patients may survive for extended periods, sometimes as long as 4-9 years.…”

Section: Introductionmentioning

confidence: 99%

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Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

2004

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Study design: Retrospective descriptive study. Objectives: (1) To obtain an overall appraisal of patients with epidural metastatic spinal cord compression (SCC) (1) Clinical records were reviewed and demographic, clinical and functional data were collected according to a protocol. The date of admittance to the SCU, rehabilitation goals, date of discharge and date of death were recorded. (2) The odds ratio (OR) was calculated for all determinants on admittance to the SCU in order to find indicators that predict survival 41 year after discharge from the SCU. An OR X2 was considered to be clinically significant. Results: In total, 131 patients with epidural metastatic SCC were admitted. In all, 117 clinical records were retrieved and 97 clinical records provided complete data. The average age on admittance was 58 years. Among the patients 53% were male. The average Barthel score on admittance was 7.2/20 points. The average length of stay in the SCU was 104 days (3-336). Overall, 66% of the patients were discharged. The average Barthel score on discharge was 12.0 points. The average survival after discharge was 808 (0-3669) days. During their stay on the SCU, seven patients died. At 1 year after discharge, 52% of the patients were still alive. These patients suffered less complications, had been admitted less often to a hospital during rehabilitation, had made better functional progress and had been discharged home more often. A survival 41 year after discharge is related to ASIA D (OR 4.3), MRC 4 and 5 (OR 5.4), tumour in remission (OR 3.8) and independence or partial independence on the Barthel items: dressing (OR 4.3) and making transfers (OR 5.0). Conclusions: Patients with epidural metastatic SCC may benefit from in-patient rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

2004

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“…We traced only one study which discussed the outcome of rehabilitation in these patients. 17 Regrettably empirical data con cerning the selection process of those SCI cancer patients who benefit from clinical rehabilitation were not published. !7 In the present study we try to identify factors which can be helpful when selecting patients for an intensive inpatient rehabil itation programme.…”

Section: -1mentioning

confidence: 99%

Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression

Hacking

As²,

Lankhorst

1993

Spinal Cord

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In this study we have tried to develop a method to predict the survival and the functional outcome following neoplastic spinal cord injury (SCI), which can be helpful when selecting patients for an intensive inpatient rehabilitation pro gramme. We reviewed the clinical records of all patients with neoplastic epidural spinal cord compression, admitted to any Dutch spinal cord unit (SCU) between 1-1-1985 and 1-1-1990 (n = 74). According to the outcome on 1-1-1991 the average stay at the SCU was 111 days, whereas the average survival after discharge was 423 days. Seven patients died during their stay. Of all of the factors analysed, six showed a positive relationship with prolonged survival (> one year after discharge) and improved functional level: tumour biology (lymphoma, myeloma, breast and kidney tumours); SCI as the presenting symptom of the malignancy; slow (> 1 week) progression rate of neurological symptoms; tumours treated with a combination of surgery and radiotherapy; (partial) bowel control at admission; and (partial) independence regarding transfer activities at admission. A sum score (range 0-6) of these indicators is introduced. A patient with a sum score of 0-1 has zero probability of living longer than one year after discharge and 0. 19 of functional improvement during stay at the SCU. A score of 5 -6 yields probabilities of 0.77 and 0.92 respectively. We conclude that the sum score can be helpful when selecting patients for an intensive inpatient rehabilitation programme or modifying such a programme. Validation for application in a general hospital is needed.

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“…[1][2][3][4][5][6] Only 10-14% of patients with a spinal epidural metastasis are admitted into a PM&R center. 7 The teams are usually not used to dealing with chronic pain, fatigue and other symptoms related to metastatic paraplegia.…”

Section: Introductionmentioning

confidence: 99%

Metastatic paraplegia: care management characteristics within a rehabilitation center

Fattal

Gault²,

Leblond³

et al. 2008

Spinal Cord

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Study design: Retrospective study. Objectives: To determine the potential impact of rehabilitation care on associated symptoms and functional improvements of paraplegic patients with metastatic spinal cord compression. Setting: CMN Propara, Montpellier (France). Measures: Demographics, Functional Independence Measure (FIM), Frankel Modified Score and Visual Analog Scale (VAS) for pain, intercurrent adverse medical events and neurological outcome, duration of stay, survival time, rehospitalization in a non-Spinal Cord Injury unit, number of contracts defining the patients rehabilitation goals, number of contracts defining the patients duration of stay within the rehabilitation center. Results: We reviewed the charts of 26 patients. The initial neurological profile was paraplegia or paraparesis for 24 patients and quadriparesis for 2 patients. Regarding functional improvements: four patients demonstrated a poor functional evolution, five patients showed no functional improvements or very slight improvements and all the other patients showed an increase in their overall functional aptitudes. At the end of the stay, 14 patients were urinary independent. Our study reports 52 rehospitalizations in an another unit and 101 outpatient visits during their rehabilitation stay in a physical medicine and rehabilitation (PM&R) center. For the 14 patients who were deceased at the time of data collection, the median survival rate post-paraplegia was 12.7 months. A total of 12 of the 14 patients spent more than a third of their remaining survival time in a rehabilitation center. Discussion: Compared to the patients' life expectancy, their stay in a rehabilitation center is too long and prevents them from spending time with family and loved ones. The occurrence rate of the associated symptoms is high because of both cancer-related disorders and neurological disorders caused by the spinal cord lesion. PM&R professionals are faced with patients affected by chronic pain and fatigue as well as frequent rehospitalizations, short stays and outpatient stays, in the primary oncology unit. This study focuses on the need to privilege the patients' comfort over their functional rehabilitation.

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Functional outcome and survival in spinal cord injury secondary to neoplasia

Cited by 42 publications

References 11 publications

Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression

Metastatic paraplegia: care management characteristics within a rehabilitation center

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