title: Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: a controlled clinical trial.
abstract: OBJECTIVE
  To evaluate effectiveness of a multidisciplinary rehabilitation program for persons following definitive primary brain tumour treatment in a community cohort.
  
  
  METHODS
  The brain tumour (glioma) survivors (n = 106) were allocated either to the treatment group (n = 53) (intensive ambulatory multidisciplinary rehabilitation), or the waitlist control group (n = 53). The primary outcome - Functional Independence Measure (FIM), measured 'Activity' limitation; secondary measures included Depression, Anxiety Stress Scale, Perceived Impact Problem Profile and Cancer Rehabilitation Evaluation System. Assessments were at baseline, 3 and 6 months after program completion.
  
  
  RESULTS
  Participants were predominantly women (56%), with mean age 51 years (standard deviation 13.6) and median time since diagnosis of 2.1 years. Intention-to-treat analysis showed a significant difference between groups at 3-month in favour of multidisciplinary rehabilitation program in FIM motor subscales: 'self-care', 'sphincter', 'locomotion', 'mobility'(p < 0.01 for all); and FIM 'communication' (p < 0.01) and 'psychosocial' subscales (p < 0.05), with small to moderate effect size (r = 0.2-0.4). At 6-month follow-up, significant improvement in the treatment group was maintained only for FIM 'sphincter', 'communication' and 'cognition' subscales (p < 0.01 for all). No difference between groups was noted in other subscales.
  
  
  CONCLUSIONS
  brain tumour survivors can improve function with multidisciplinary rehabilitation, with some gains maintained up to 6 months. Evidence for specific interventions in the 'blackbox' of rehabilitation is needed.
authors.affiliation: Department of Rehabilitation Medicine, Royal, Melbourne Hospital, 34-54 Poplar Road, Parkville, Melbourne VIC 3052, Australia. fary.khan@mh.org.au.
authors.forename: Fary
authors.initials: F
authors.lastname: Khan
authors.forename: Bhasker
authors.initials: B
authors.lastname: Amatya
authors.forename: Kate
authors.initials: K
authors.lastname: Drummond
authors.forename: Mary
authors.initials: M
authors.lastname: Galea
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D001932:Brain Neoplasms / Q000145:classification / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D005910:Glioma / Q000145:classification / Q000534:rehabilitation*; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D017741:Survivors / Q000523:psychology; D014739:Victoria; D055815:Young Adult