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

Abstract

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% (n=67) were male. The median age was 61.5 years (interquartile range (IQR) 53.6-74). Most patients had paraplegia (n=97, 89.8%) and a metastatic tumour (n=71, 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 (P=0.006) than for those with secondary tumour (median 7, IQR from -4 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 (P=0.01). 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, P=0.03) 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. © 2012 International Spinal Cord Society All rights reserved.