title: Multidisciplinary rehabilitation after primary brain tumour treatment.
abstract: BACKGROUND
  Brain tumours can cause significant disability, which may be amenable to multidisciplinary rehabilitation. However, the evidence base for this is unclear.
  
  
  OBJECTIVE
  To assess the effectiveness of multidisciplinary rehabilitation in adults after primary brain tumour treatment, especially the types of approaches that are effective (settings, intensity) and the outcomes that are affected.
  
  
  METHODS
  We searched the Cochrane Neuromuscular Disease Group Specialized Register (March week 2, 2012), The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 3, 2012), MEDLINE (1966 to March week 2, 2012), EMBASE (1980 to March week 2, 2012), PEDro (1982 to March 2012) and LILACS (1982 to March week 2, 2012). We checked the bibliographies of papers identified and contacted the authors and known experts in the field to seek published and unpublished trials.
  
  
  METHODS
  Controlled clinical trials (randomised and non-randomised clinical trials) that compared multidisciplinary rehabilitation in primary brain tumour with either routinely available local services or lower levels of intervention, or studies that compared multidisciplinary rehabilitation in different settings or at different levels of intensity.
  
  
  METHODS
  Three review authors independently assessed study quality, extracted data and performed a 'best evidence' synthesis based on methodological quality.
  
  
  RESULTS
  No randomised controlled trials (RCTs) or controlled clinical trials (CCTs) were identified.
  
  
  CONCLUSIONS
  No RCTs or CCTs were available for synthesis of 'best evidence' for multidisciplinary rehabilitation after treatment for brain tumour patients. However, this does not suggest the ineffectiveness of multidisciplinary rehabilitation but rather highlights the challenges in trial design and rigour, outcome measurement and complexities of care in this population. For completeness of literature, 12 observational studies (with high risk of bias) involving patients with brain tumours were included. These studies provided 'very low level' evidence suggesting that multidisciplinary rehabilitation (inpatient, home-based) may improve functional outcomes, and ambulatory programmes (outpatient and home-based) may improve vocation and quality of life. These conclusions are tentative at best, given gaps in current research in this area. Further research is needed into appropriate and robust study designs, outcome measurement, caregiver needs, evaluation of optimal settings, type, intensity, duration of therapy, and cost-effectiveness of multidisciplinary rehabilitation in the brain tumour population.
authors: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia. fary.khan@mh.org.au.
authors: Fary
authors: F
authors: Khan
authors: Bhasker
authors: B
authors: Amatya
authors: Louisa
authors: L
authors: Ng
authors: Kate
authors: K
authors: Drummond
authors: John
authors: J
authors: Olver
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000534:rehabilitation* / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D011788:Quality of Life