Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours
Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours
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DOI：
10.1007/s11060-011-0772-5
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发表时间：
2012-05-01
影响因子：
3.9
通讯作者：
Pierelli, Francesco
中科院分区：
文献类型：
--
作者：
Bartolo, Michelangelo;Zucchella, Chiara;Pierelli, Francesco
临床经验表明，应用康复医学的基本原则，可以改善癌症患者的护理。尽管受脑肿瘤（BT）影响的患者神经和功能缺陷的发生率很高，但对这一人群的康复治疗并不像对其他神经系统疾病患者那样完善。评估脑肿瘤住院患者术后接受早期康复治疗的功能结局。75例因原发性BT接受神经外科手术的患者和75例受卒中影响的患者入组病例对照研究。所有患者均通过一组核心临床量表（功能独立性测量、坐姿平衡评分、站立平衡评分、豪瑟指数、马萨诸塞州综合医院功能Ambassador分级）进行评价。在康复治疗开始前（T0）和结束时（T1）对患者进行评估。神经康复计划包括个人60分钟的治疗，每天一次，每周六天，连续四周。当失语症被诊断时，包括语言治疗。所有结果指标均表明神经肿瘤和卒中患者的显著改善（P = 0.000）。亚组分析显示，与胶质母细胞瘤或卒中患者相比，脑膜瘤患者在日常生活活动独立性（P = 0.02）和活动能力（P = 0.04）方面取得了更好的结果（在效率方面）。手术后的康复可以改善功能结果，证明即使在急性期，无论肿瘤类型如何，都应该向BT住院患者提供康复服务。
Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer. Despite the high incidence of neurological and functional deficits in patients affected by brain tumours (BTs), rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions. To assess functional outcome in brain tumour inpatients who underwent early rehabilitation after surgery. 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study. All patients were evaluated by means of a core set of clinical scales (Functional Independence Measure, Sitting Balance score, Standing Balance score, Hauser Index, Massachusetts General Hospital Functional Ambulation Classification). Patients were evaluated before the beginning (T0) and at the end (T1) of rehabilitation treatment. The neurorehabilitation programme consisted of individual 60-min sessions of treatment, administered once a day, six days a week, for four consecutive weeks. Speech therapy was included when aphasia was diagnosed. All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients (P = 0.000). Analysis of subgroups showed that patients affected by meningioma achieved better results (in efficiency terms) as regards independence in activities of daily living (P = 0.02) and mobility (P = 0.04) compared with patients affected by glioblastoma or stroke. Rehabilitation after surgery can improve functional outcome, justifying the delivery of rehabilitation services, even during the acute phase, to BTs inpatients, irrespective of tumour type.