title: Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning.
abstract: METHODS
  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.
  
  
  METHODS
  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 (P<0.0001). 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) (P<0.005); and high FIM change (>13) compared to low FIM change (< or =13) (P<0.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio (OR)=1.30, 95% confidence interval (CI)=1.04-1.62) and length of rehabilitation (OR=1.04, 95% confidence interval (CI)=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.
authors.affiliation: Department of Medicine, Division of Neurology, McMaster University Hamilton, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Tang
authors.forename: D
authors.initials: D
authors.lastname: Harvey
authors.forename: J
authors.initials: J
authors.lastname: Park Dorsay
authors.forename: S
authors.initials: S
authors.lastname: Jiang
authors.forename: M P
authors.initials: MP
authors.lastname: Rathbone
mesh_terms: D000203:Activities of Daily Living; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology* / Q000534:rehabilitation*; D013125:Spinal Neoplasms / Q000401:mortality* / Q000556:secondary*