| dc.description.abstract | Aim: The decision to surgically treat patients with spinal bone metastases at the end-stage of their life is supported by medical scoring systems. Personal goals of patients are not included in these scoring systems and are rather based on independent mobility and ambulatory status. It is furthermore not clear what kind of physical therapy patients receive to achieve these goals. The aim of this pilot study is to better understand the functional status of patients before and after surgery, understand patients’ main goals and whether they achieve them, and gain insight into the type of physical therapy patients receive in addition to surgery and whether
preoperative physical therapy is achievable.
Methods: This observational pilot cohort study was performed at the orthopedic department of the University Medical Centre Utrecht, the Netherlands. A convergent mixed method study was used. Quantitative data consisted of the Tokuhashi, Tomita and the Karnofsky Performance Score, the Numeric Rating Scale and EuroQol-5D questionnaire, both preoperative and three months after surgery. Additional qualitative data were both collected preoperatively (Patient Specific Questionnaire) as well as six weeks after surgery (semi-structured interviews).
Results: Quantitative data were taken from an existing dataset covering 51 patients. Patients’ functional status improved significantly after surgery, as did their pain level, mobility, self-care and ability to perform daily activities. Qualitative data were collected from six patients. The goals and expectations of patients were improving the ability to perform daily activities. Physical therapy practices after discharge differed by patient. For various reasons there was no possibility for preoperative training.
Conclusion: The goals of patients with spinal bone metastases differ from current standard medical scoring systems. Preoperative physical therapy is only achievable if patients are referred to an orthopedic surgeon at an earlier stage. Referral to physical therapy after discharge has to be optimized in order to facilitate patients in meeting the goals they set themselves prior to surgery.
Clinical relevance: The referral policy to the orthopedic surgeon in the preoperative phase and to the physical therapist in the postoperative phase can improve the feasibility of meeting goals patients with spinal metastases set themselves prior to surgery. | |
