Metastatic paraplegia: care management characteristics within a rehabilitation center

Abstract

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.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes

“…Similar conclusions have been made by other groups that examined the outcome of patients with metastatic spinal cord lesions. 12 In our patients, the need for early discharge was avoided because of the nature of their tumors; most patients had a prognosis of several months or longer, which allowed protracted rehabilitation stays.…”

“…[2][3][4][5][6][7][8][9][10][11][12] Most such studies, however, examined metastatic spinal cord compression only, and although they have demonstrated the benefits of rehabilitation in neoplastic patients with regard to pain, independence, prevention of complications and survival, they failed to make comparisons with traumatic SCI (TSCI) patients. [5][6][7][9][10][11][12] Thus, few studies have compared the outcomes of NSCI and TSCI patients, likely because of differences in prognostic factors (age, lesion severity and level, and lesion-to-rehabilitation hospital admission time) between these groups that render them incomparable.…”

Rehabilitation of people with spinal cord damage due to tumor: literature review, international survey and practical recommendations for optimizing their rehabilitation

“…5,10,[12][13][14][15][16]25,26 The key findings from these are summarized in Table 1. A number of reports compared people with SCDys due to tumor to those with traumatic SCI and found that the tumor group had a shorter length of stay in SRU, comparable improvement in functional abilities and similar rates of discharge back into the community.…”

“…[7][8][9] The bias of SRUs against admitting people with SCDys appears to be particularly strong regarding those people with SCDys due to tumor, 10,11 although numerous SRUs do admit these patients. 5,10,[12][13][14][15][16][17] It is acknowledged that the rehabilitation of patients with tumor presents unique challenges, 18 and this applies especially for those with tumor as the cause of SCDys. 10,16,[19][20][21] Despite the high proportion of people with tumor causing SCDys there has been relatively little written about these patients in terms of the ideal setting for their rehabilitation or recommendations for rehabilitation teams caring for them.…”

Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study

“…Among patients with MSCC, even more difficult to quantify is the opportunity cost of rehabilitation in terms of time away from family members and loved ones in the context of finite survival. 14 Current research on rehabilitation following MSCC [15][16][17][18][19][20][21][22][23][24][25][26] is comprised of predominantly small retrospective chart reviews with sample sizes ranging from 26 24 to 108 25,26 patients, in a maximum of seven centers. 16 Though some of these studies have compared …”