title: Directed rehabilitation reduces pain and depression while increasing independence and satisfaction with life for patients with paraplegia due to epidural metastatic spinal cord compression.
abstract: We determined whether directed rehabilitation affected survival, pain, depression, independence, and satisfaction with life for veterans who were nonambulatory after spinal epidural metastasis (SEM) treatment. We compared 12 consecutive paraplegic veterans who received 2 weeks of directed rehabilitation with a historical control group of 30 paraplegic veterans who did not receive rehabilitation. The rehabilitation program emphasized transfers, bowel and bladder care, incentive spirometry, nutrition, and skin care. The outcome measures were survival, independence, pain levels, depression, and satisfaction with life. Patients receiving rehabilitation had longer median survivals, fewer deaths from myelopathic complications, less pain 2 weeks after SEM treatment, lower depression scores, and higher satisfaction with life scores. In addition, among the patients who received rehabilitation, eight became independent for transfers (vs zero controls) and nine returned home (vs six controls). We conclude that directed rehabilitation reduced patients' pain levels and increased their mobility, survival, and life satisfaction.
authors.affiliation: Neurology and Spinal Cord Injury and Dysfunction Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA. robert.ruff1@va.gov
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ruff
authors.forename: Van W
authors.initials: VW
authors.lastname: Adamson
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Ruff
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D003863:Depression / Q000209:etiology / Q000534:rehabilitation; D006787:Hospitals, Veterans; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000534:rehabilitation; D010264:Paraplegia / Q000209:etiology / Q000534:rehabilitation*; D011446:Prospective Studies; D011788:Quality of Life; D012138:Respiratory Therapy; D013117:Spinal Cord Compression / Q000209:etiology / Q000534:rehabilitation*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000534:rehabilitation / Q000556:secondary; D016019:Survival Analysis