Brain tumour rehabilitation guidelines
95
with BT; the paediatric BT population was beyond
the scope of the review and expertise of the research
team. Interestingly, the majority of published CPGs
on BT were generally more attentive to the medical,
surgical and radiological treatments, and only 2 CPGs
included information on rehabilitation approaches.
The underlying evidence for the recommendations in
both of the included CPGs (NICE and ACN) appears
outdated and old (> 10 years) (update of the NICE
guidelines is currently in progress; personal communi-
cation with the developers). To our knowledge, a large
body of evidence (clinical trials, systematic reviews)
is now available since the development of these 2
CPGs. Examination of this evidence will be critical in
formulating the recommendations in future updates or
development of new CPGs in this area. rehabilitation interventions is scarce (2, 11). There is
lack of robust studies evaluating the effectiveness of
many rehabilitation interventions. The findings from
this review highlight the need for systematic data
collection in clinical practice and research into the
course of BT, including long-term follow-up outcomes.
Although randomized controlled trials (RCTs) are
considered the “gold standard” for high-level evidence,
they are less appropriate in studying rehabilitation in-
terventions. Patients’ (and/or caregivers’) perspective
must be incorporated into rehabilitation programmes.
Outcome measures should reflect activity and restric-
tion in participation. There is a need for a suitable
battery of measures to capture change in physical
ability, symptoms and longer-term outcomes relating
to psychosocial adjustment and QoL.
Implications for clinical practice Conclusion
BT have a significant effect on both survivors and
their caregivers/family (5). In the community patients
are often confronted by new care demands, personal
relationship, financial constraints, relationship stress,
relapse, recurrence, etc., requiring integrated multidis-
ciplinary care, including rehabilitation (38). However,
there is lack of awareness about the integral role of
rehabilitation amongst many healthcare professionals,
as surgical, medical, and radiological treatments are
considered a priority. The aim of BT rehabilitation is
not only management of disability and/or minimizing
symptoms and treatment-related complication effects,
but also enhancing participation. Interventions such
as physical therapy, psychological interventions (psy-
chotherapy, cognitive behaviour training) and others
can reduce disability, and improve participation.
This review was unable to synthesize rehabilitation-
related recommendations sufficiently from the publi
shed CPGs, due to the limited numbers of BT CPGs
with rehabilitation management, and the inconsistency
in reporting underlying evidence to support these
recommendations. The 2 included CPGs (NICE and
ACN), were moderate in quality, and the overall re-
commendations formulated were generic. This resulted
in difficulty in comparing and summarizing recom-
mendations for rehabilitation approaches. However,
both CPGs recommend comprehensive assessment of
functional limitations and the various levels of disa-
bility in this population at regular intervals in order to
establish a better care model and to optimize physical
independence and participation (12). This study reviews CPGs for the management of
persons with BT from the rehabilitation perspective.
Delivery of rehabilitation interventions in patients with
BT should not differ from other neurological condi-
tions, such as stroke or traumatic brain injury; however,
owing to the disease characteristics, rehabilitation is of-
ten overlooked in this patient cohort. Current CPGs for
the management of BT do not provide consistent and
detailed information on rehabilitation management;
thus it is challenging to synthesize recommendations
for rehabilitation approaches specific to BT survivors.
Both of the guidelines included in this review provide
generic recommendations regarding rehabilitation
modalities. Developers of future CPGs should com-
prehensively evaluate and incorporate rehabilitation
modalities in the management of patients with BT, so
that these interventions can be integrated into routine
clinical practice in order to improve patient outcomes.
Implications for research
Despite evidence to support rehabilitation interven-
tions in patients with BT (2, 11), literature evaluating
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