Journal of Rehabilitation Medicine 51-2 | Page 14

J Rehabil Med 2019; 51: 89–96 REVIEW ARTICLE CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF BRAIN TUMOURS: A REHABILITATION PERSPECTIVE Woo-Jin KIM, MD, PhD 1 *, Klara NOVOTNA 2 , Bhasker AMATYA, DMedSci, MPH, MD 3–5 and Fary KHAN, MBBS, MD, FAFRM (RACP) 3–6 From the 1 Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, South Korea, 2 Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic, 3 Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, 4 Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, 5 Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, and 6 School of Public Health and Preventive Medicine, Monash University, Victoria, Australia Objective: To critically appraise published clinical practice guidelines (CPGs) for brain tumours, and to synthesize evidence-based recommendations from a rehabilitation perspective. Methods: A comprehensive literature search inclu- ded: health science databases, CPG clearinghouse/ developer websites, and grey literature up to March 2018. All brain tumour CPGs that reported systema- tic methods for evidence search, and clearly defined recommendations supporting evidence for rehabi- litation interventions were included. Three authors independently selected potential CPGs and asses- sed their methodological quality using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) Instrument. Recommendations from included CPGs were categorized from a rehabilitation perspective. Results: Of the 11 CPGs identified, only 2, develo- ped by the National Institute for Health and Clinical Excellence (NICE) and the Australian Cancer Net- work (ACN), included rehabilitation components for the management of brain tumours. Both CPGs were of moderate quality. The recommendations repor- ted were generic, and only the ACN guidelines pro- vided detailed recommendations for rehabilitation interventions. Both guidelines recommend a com- prehensive multi-disciplinary care approach. Detai- led comparison, however, was not possible due to inconsistent recommendations, making it difficult to summarize rehabilitative care. Conclusion: Despite rehabilitation being an integral component of the management of brain tumours, only a limited number of CPGs have incorporated re- commendations for specific rehabilitation interven- tions. In order to improve clinical outcomes in this population future CPGs should incorporate rehabili- tation interventions. Key words: brain tumour; rehabilitation; clinical practice gui- delines; critical appraisal. Accepted Oct 29, 2018; Epub ahead of print Nov 28, 2018 J Rehabil Med 2019: 51: 89–96 *Correspondence address: Woo-Jin Kim, Department of Physical Medi- cine and Rehabilitation, Haeundae Paik Hospital, University of Inje Col- lege of Medicine, Busan, South Korea. E-mail: [email protected] LAY ABSTRACT Brain tumours cause significant disability and morbidity. There are numerous published clinical practice guideli- nes (CPGs) for the management of brain tumours, and rehabilitation is recognized as an integral component of management of brain tumours. However, only limited numbers of these CPGs incorporate recommendations for specific rehabilitation interventions. To establish un- derstanding of the issues of rehabilitation needs in brain tumours survivors, and synthesise evidence-based re- commendations from rehabilitation perspective, publis- hed CPGs for brain tumours were critically appraised. Gaps in current literature were identified, and need of incorporation of rehabilitation interventions are high- lighted. This is for future direction/recommendations in developing new CPGs to guide clinicians and to improve clinical outcomes in this population. B rain tumours (BT) comprise 2% of all cancers, affecting 7 per 100,000 population annually worldwide (1). Overall incidence of BT is increasing, especially in the population over 60 years of age (2). In Australia, there are an estimated 1,400 new cases per annum, which account for 1,200 deaths annually (3). BT can have a devastating impact on patients (carers/ family) and are associated with significant costs and socioeconomic implications, with increased demand for healthcare, social and vocational services (3, 4). In Australia, the estimated mean overall healthcare system cost of BT is 5 times higher than for patients with breast or prostate cancer (5). Recent therapeutic advances have improved the survival rates of persons with BT. However, many have residual neurological deficits, leading to physical, cognitive, psychosocial and behavioural impairments, which limit everyday activity and participation (6, 7). Furthermore, many treatments for BT, such as radio­ therapy, chemotherapy and surgery are associated with adverse events. Therefore, patients require integrated and coordinated long-term management, including re- habilitation, for improvements in their functional, men- tal and emotional state, and quality of life (QoL) (7). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2509