title: The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma.
abstract: OBJECTIVE
  To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor.
  
  
  METHODS
  A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013.
  
  
  METHODS
  An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation.
  
  
  METHODS
  Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation.
  
  
  METHODS
  Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program.
  
  
  RESULTS
  A total of 89 patients (93.7%) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8%), followed by self-care (88.4%), communication/social cognition (75.8%), and sphincter control (50.5%). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient rehabilitation (P = .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P = .16). Among the patients who underwent inpatient rehabilitation, older age (HR, 2.24; P = .0006), a low degree of resection (HR, 1.67; P = .02), and lack of a Stupp regimen (HR, 1.71; P = .05) were associated with greater hazard of mortality.
  
  
  CONCLUSIONS
  Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multivariate analysis showed no survival difference between patients who did and did not undergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, 8631 West Third St, Suite 915 East, Los Angeles, CA 90048∗. Electronic address: pamela.roberts@cshs.org.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Roberts
authors.affiliation: Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA(†).
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA(‡).
authors.forename: Dale
authors.initials: D
authors.lastname: Sherman
authors.affiliation: Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA(§).
authors.forename: Arash
authors.initials: A
authors.lastname: Asher
authors.affiliation: Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA(¶).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wertheimer
authors.affiliation: Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA(‖).
authors.forename: Richard V
authors.initials: RV
authors.lastname: Riggs
authors.affiliation: Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA∗∗
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D026741:Physical Therapy Modalities; D016016:Proportional Hazards Models; D011788:Quality of Life; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population