Functional state and rehabilitation of patients after primary brain tumor surgery for malignant and non-malignant tumors: a prospective observational study

Background: There have been several attempts to develop rehabilitation programs for brain tumor patients with poor quality of life, but these studies usually failed to take tumor malignancy into account. Determining the functional status throughout postoperative recovery would help us to understand the dynamics and effectiveness of rehabilitation, and taking tumor type into account may help to preselect patients for rehabilitation services or prioritize needs. The aim of this study was to compare the pre- and post-operative function of patients qualifying for initial resection of malignant and non-malignant primary brain tumors to determine the relationship between tumor type, function, and the course of rehabilitation after surgery. Methods: : This was a single-center, prospective, observational study (two intervention groups) conducted in a tertiary neurosurgical inpatient unit. Ninety-two patients required prolonged postoperative rehabilitation during their inpatient stay and were divided into a non-malignant tumor group ( n =66) and a malignant tumor group ( n =26). The Karnofsky performance status, Barthel index, and the modified Rankin scale were used to assess functional status, while the gait index was used to assess gait efficiency. Motor skills, postoperative complications, and length of hospital stay (LoS) were recorded and compared between groups. Results: : The frequency and severity of postoperative complications, the time needed to attain individual motor skills, and the proportion of patients who lost independent gait (~30%) were similar between non-malignant and malignant groups. However, paralysis and paresis were more frequent in the malignant tumor group before surgery (p<0.001). While non-malignant tumor patients deteriorated more according to all scales after surgery, patients with malignant tumors were still characterized by worse ADL, independence, and performance at discharge. Worse functional outcomes in the malignant tumor group did not affect LoS or rehabilitation. Conclusions: : Patients with malignant and non-malignant tumors have similar rehabilitation needs, and patient expectation – especially those with non-malignant tumors - should be appropriately managed. Counterintuitively, patients with non-malignant tumors might require more rather than less counselling and support given their greater deterioration after surgery.