Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Parsch, Dominik; Mikut, Ralf; Abel, Rainer

doi:10.1038/sj.sc.3101426

Cited by 46 publications

(31 citation statements)

References 22 publications

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“…The FIM efficiency from our study was 0.38 per day. This value is comparable to those reported in previous studies with metastatic spinal cord injury of 0.33 per day 7 and 0.42 per day. 9 The FIM efficiency was lower in patients with metastatic cancer than in patients with traumatic spinal cord injury, which has been reported as 0.75 per day 10 and 1.3 per day.…”

Section: Discussionsupporting

confidence: 91%

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

et al. 2007

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Study design: Retrospective, descriptive study. Objective: To determine if patients with metastatic spinal cord compression (MSCC) make significant functional gains through rehabilitation. To study survival and predictors of survival in MSCC. To explore predictive factors for high or low functional gains in MSCC. Setting: Inpatient neuro-oncology rehabilitation ward, Henderson General Hospital, Hamilton, Canada. Methods: Clinical records were examined for 63 inpatients with MSCC. Demographics, treatment of MSCC, length of rehabilitation, admission, and discharge Functional Independence Measure (FIM) scores, Tokuhashi score and survival data were collected. Statistical analyses included nonparametric comparisons, Kaplan-Meier analyses, Cox regression, and exploratory logistic regression. Results: FIM score improved from 83 to 102 (Po0.0001). Estimated median survival from time of rehabilitation was 10.0 months. Kaplan-Meier analysis showed longer survival in patients with high Tokuhashi scores (9-15) compared to low scores (0-8) (Po0.005); and high FIM change (413) compared to low FIM change (p13) (Po0.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio (OR) ¼ 1.30, 95% confidence interval (CI) ¼ 1.04-1.62) and length of rehabilitation (OR ¼ 1.04, 95% confidence interval (CI) ¼ 1.01-1.07) were associated with high FIM gain. Conclusions: Rehabilitation improves functional outcomes in MSCC. Patients who had a high Tokuhashi score and achieved high functional gains after rehabilitation had longer survival. Tokuhashi score and length of rehabilitation were associated with high FIM gain. The Tokuhashi score can help identify patients with good prognosis and potential for improvement during rehabilitation.

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Section: Discussionsupporting

confidence: 91%

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

et al. 2007

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“…To identify patients with long life expectancies who could benefit from such a program, prognostic indicators such as young age, incomplete SCI, good functional status at admission and the scoring system of Tokuhashi et al 29 should be considered. 6,7 …”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Background: Although neoplastic spinal cord injuries (NSCIs) constitute B25% of all non-traumatic spinal cord lesions, patients with such pathologies are seldom, if ever, admitted to specialized centers; further, their rehabilitation typically is short because of the perception that rehabilitation prolongs hospital stays unnecessarily and is reserved only for patients with very good prognoses. Study design: This study is a retrospective analysis. Objective: The objective of this study is to evaluate the neurological and functional outcomes of patients with NSCIs compared with those of patients with traumatic spinal cord injury (TSCI). Methods: We evaluated 208 patients with TSCIs and 63 with NSCIs; using a matching cohorts procedure, 43 comparable couples were selected from each group. The measures used to assess these patients were the American Spinal Injury Association standards, the Barthel Index (BI), the Rivermead Mobility Index and the Walking Index for Spinal Cord Injury. Results: In the general population, NSCI patients are older and have longer lesion-to-admission times and more incomplete lesions than TSCI patients. Therefore, the functional status at admission and outcomes differed between the groups. In the matching cohorts, TSCI patients had lower BI scores at admission than NSCI subjects. At discharge, the two groups had comparable functional outcomes. Neurological status was similar at admission and at discharge. Conclusions: Although they had slightly disparate functional levels at admission, NSCI and TSCI patients had the same outcomes at discharge. Our data suggest that in a selected cohort of NSCI patients, rehabilitation is as successful as that in TSCI subjects and allows most patients to be discharged instead of being institutionalized.

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“…Most studies to date of SCI due to tumour have concentrated on prognostication and functional outcome without examining the effect of pain. Previous studies have usually reported total FIM scores, 10 with only a few reporting separate motor and cognitive subscales. Our results differ from previous studies that reported mean FIM motor gains of 32 (ref.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Previous reports on their rehabilitation outcomes have been published. [7][8][9][10] These patients can have a relatively short survival, 11,12 and have a peak age at the time of diagnosis of between 50 and 70 years. 13 With the ageing population and improvements in early cancer diagnosis and treatment leading to increased survival, the number of patients with SCI due to tumour with the potential to benefit from rehabilitation is increasing.…”

Section: Introductionmentioning

confidence: 99%

Retrospective study of rehabilitation outcomes following spinal cord injury due to tumour

Tan

New

2011

Spinal Cord

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Study design: Retrospective study. Objectives: To examine the rehabilitation outcomes for patients with spinal cord injury (SCI) due to tumour, with a focus on the impact of pain on disability and length of stay (LOS). Setting: Public hospital inpatient spinal rehabilitation unit, Melbourne, Australia.Methods: Retrospective open-cohort case series of consecutive patients admitted between 1/7/1996 and 30/6/2008 with a diagnosis of recent onset tumour causing SCI. Results: In all 108 patients were admitted, of whom 62% (n¼67) were male. The median age was 61.5 years (interquartile range (IQR) 53.6-74). Most patients had paraplegia (n¼97, 89.8%) and a metastatic tumour (n¼71, 65.7%) causing their SCI. For patients with a primary tumour the Rasch motor functional independence measure (FIM) gain between admission and discharge (median 17, IQR 4-23) was significantly greater (P¼0.006) than for those with secondary tumour (median 7, IQR from À4 to 15). Pain was present in 52% of patients and had a significant adverse influence on the rehabilitation process, with FIM motor efficiencies of 0.09 in patients with documented pain compared with 0.39 in patients without pain (P¼0.01). Patients with pain had significantly prolonged median LOS of 56 days (IQR 32.5-84.5) compared with 42 days (IQR 20.5-72.5, P¼0.03) without pain. Conclusion: Patients with SCI due to tumour have the potential to benefit from a focused, specialised SCI rehabilitation programme to optimise their outcomes. Careful patient selection, modifying the focus of team goals and a close relationship with treating oncologists and palliative care teams is essential.

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Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Cited by 46 publications

References 22 publications

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

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

Retrospective study of rehabilitation outcomes following spinal cord injury due to tumour

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