The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma

Pamela S. Roberts, Miriam A Nuno, Dale Sherman, Arash Asher, Jeffrey Wertheimer, Richard V. Riggs, Chirag G. Patil

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor. Design: A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013. Setting: An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation. Participants: Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation. Main Outcome Measurements: Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program. Results: A total of 89 patients (93.7%) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8%), followed by self-care (88.4%), communication/social cognition (75.8%), and sphincter control (50.5%). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient rehabilitation (P= .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P= .16). Among the patients who underwent inpatient rehabilitation, older age (HR,2.24; P= .0006), a low degree of resection (HR, 1.67; P= .02), and lack of a Stupp regimen (HR, 1.71; P= .05) were associated with greater hazard of mortality. Conclusions: Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multivariate analysis showed no survival difference between patients who did and did not undergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis.

Original languageEnglish (US)
Pages (from-to)514-521
Number of pages8
JournalPM and R
Volume6
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Glioblastoma
Inpatients
Rehabilitation
Survival
Karnofsky Performance Status
Self Care
Brain Neoplasms
Cognition
Cohort Studies
Multivariate Analysis
Survival Rate
Retrospective Studies
Communication

ASJC Scopus subject areas

  • Rehabilitation
  • Neurology
  • Clinical Neurology
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma. / Roberts, Pamela S.; Nuno, Miriam A; Sherman, Dale; Asher, Arash; Wertheimer, Jeffrey; Riggs, Richard V.; Patil, Chirag G.

In: PM and R, Vol. 6, No. 6, 01.01.2014, p. 514-521.

Research output: Contribution to journalArticle

Roberts, Pamela S. ; Nuno, Miriam A ; Sherman, Dale ; Asher, Arash ; Wertheimer, Jeffrey ; Riggs, Richard V. ; Patil, Chirag G. / The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma. In: PM and R. 2014 ; Vol. 6, No. 6. pp. 514-521.
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abstract = "Objective: To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor. Design: A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013. Setting: An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation. Participants: Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation. Main Outcome Measurements: Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program. Results: A total of 89 patients (93.7{\%}) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8{\%}), followed by self-care (88.4{\%}), communication/social cognition (75.8{\%}), and sphincter control (50.5{\%}). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient rehabilitation (P= .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P= .16). Among the patients who underwent inpatient rehabilitation, older age (HR,2.24; P= .0006), a low degree of resection (HR, 1.67; P= .02), and lack of a Stupp regimen (HR, 1.71; P= .05) were associated with greater hazard of mortality. Conclusions: Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multivariate analysis showed no survival difference between patients who did and did not undergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis.",
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AU - Roberts, Pamela S.

AU - Nuno, Miriam A

AU - Sherman, Dale

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AU - Wertheimer, Jeffrey

AU - Riggs, Richard V.

AU - Patil, Chirag G.

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AB - Objective: To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor. Design: A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013. Setting: An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation. Participants: Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation. Main Outcome Measurements: Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program. Results: A total of 89 patients (93.7%) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8%), followed by self-care (88.4%), communication/social cognition (75.8%), and sphincter control (50.5%). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient rehabilitation (P= .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P= .16). Among the patients who underwent inpatient rehabilitation, older age (HR,2.24; P= .0006), a low degree of resection (HR, 1.67; P= .02), and lack of a Stupp regimen (HR, 1.71; P= .05) were associated with greater hazard of mortality. Conclusions: Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multivariate analysis showed no survival difference between patients who did and did not undergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis.

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