title: Prospective assessment of activities of daily living using modified Barthel's Index in children and young adults with low-grade gliomas treated with stereotactic conformal radiotherapy.
abstract: OBJECTIVE
  To report prospective evaluations of activities of daily living (ADL) in young patients with low-grade gliomas treated with stereotactic conformal radiotherapy (SCRT).
  
  
  METHODS
  Between April 2001 and February 2008, 38 children and young adults (age 5-25 years, median 12.5 years) with low-grade gliomas with residual/progressive disease and treated with SCRT were accrued in a prospective protocol. Patients underwent baseline and follow-up ADL assessments by the modified Barthel's battery, which comprises domains of personal hygiene, bathing self, feeding, toilet, stair climbing, dressing, bowel control, bladder control, ambulation, and chair-bed transfer.
  
  
  RESULTS
  The patient population consisted of 38 patients (male 29, female 9) with a diagnosis of residual or progressive low-grade glioma (pilocytic astrocytoma in 27, fibrillary astrocytoma in 5, ependymoma in 4, and oligodendroglioma and pleomorphic xanthoastrocytoma in 1 each). Three patients were visually handicapped. Mean of total modified Barthel's ADL score (Barthel' Index, BI) at baseline before staring SCRT was 94.5 (standard deviation 14.8, range 45-100). At 2-year and 3-year follow-up, mean BI was 97.1 and 99, respectively. At baseline pre-radiotherapy assessment, patients with impaired visual function and with low performance status (Karnofsky performance score, KPS < 70) had significantly lower BI than those with normal vision (P <or= 0.001) and with good performance status (P = 0.001). On follow-up, maximum improvement in individual BI was seen in the ambulation-related domain in patients with impaired visual function (P = 0.027), low KPS (P = 0.015), and age less than 13 years (P = 0.103). The mean pre-radiotherapy baseline BI of three patients, who eventually developed local recurrence, was only 64 (SD 32.1) as compared with a baseline score of 97.18 seen in patients whose tumor remained controlled at follow-up (P <or= 0.001).
  
  
  CONCLUSIONS
  Young patients with low-grade gliomas after surgical intervention had a lower than normal BI before starting radiotherapy, suggesting a decrease in ADL possibly due to tumor- and surgery-related factors. At 2-year and 3-year follow-up after SCRT, there was no further decrease in mean BI. A significant improvement in BI was seen in visually handicapped patients, patients with poor performance status, and younger patients. Patients who developed tumor recurrence at follow-up had a significantly lower BI at baseline than patients with controlled disease (P <or= 0.001).
authors.affiliation: Department of Radiation Oncology, Mumbai, India. rjalali@tmc.gov.in
authors.forename: Rakesh
authors.initials: R
authors.lastname: Jalali
authors.forename: Debnarayan
authors.initials: D
authors.lastname: Dutta
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kamble
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Anusheel
authors.initials: A
authors.lastname: Munshi
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarin
authors.forename: Ketayun
authors.initials: K
authors.lastname: Dinshaw
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000145:classification / Q000523:psychology* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000145:classification / Q000523:psychology* / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D011795:Surveys and Questionnaires; D055815:Young Adult