A Multidisciplinary Pathway for Patients Post–Brain Mass Resection: A Pilot Study

There is lack of evidence-based practice for rehabilitation of patients after brain mass resection (BMR). The ‘AM-PAC 6-Clicks mobility and daily activity measures’ predictive ability for discharge destination allows physical and occupational therapists to provide accurate, objective and simple measures of functional status to help facilitate the discharge decision-making process.’ The aim of the study was to standardize care, improve patient outcomes, and reduce cost of care. This cohort study’s inclusion criteria included: patients post BMR while hospitalized and at least one therapy consult during their admission. Exclusion criteria included: patients without therapy orders, who required an extra-ventricular or lumbar drain post-op, required guardianship, or who suffered a stroke post-op. Patient’s functional status was scored utilizing the AM-PAC short form. Patients were seen daily by PT and OT for the first three days after consult. Patients were then assigned to a standardized therapy frequency based on AM-PAC score. An AM-PAC score of 17 or greater were continued to be seen daily, and a score of 16 or less was seen 3-5x/week. The scores were recorded during each therapy session and frequency was adjusted per protocol. 22 patients were included pre-protocol implementation, and 23 patients during post-protocol implementation. There was no significant change in length of stay (LOS) pre and post implementation. However, post-acute rehabilitation facility utilization decreased. When adjusting LOS from day of surgery completion to when therapy cleared the patient for discharge, we observed 4.37 days pre-protocol and 4.22 days post-protocol. This study describes the utilization of the AMPAC short forms to develop a hospital pathway for rehabilitation of patients after BMR. This data was used to develop a guideline for acute care PT, OT and SLP to establish frequency and standardize care for this patient population.

References

Burgess, G., & Jensen, L. E. (2019). Occupational therapy for adults with brain tumors in the acute care setting. NeuroRehabilitation, 45(2), 151–161. https://doi.org/10.1097/CPT.0000000000000128.

Khan, F., Amatya, B., Ng, L., Drummond, K., & Galea, M. (2015). Multidisciplinary rehabilitation after primary brain tumour treatment. Cochrane Database of Systematic Reviews, (8). https://doi.org/10.1002/14651858.CD009509.pub3

Warren, M., Knecht, J., Verheijde, J., & Tompkins, J. (2021). Association of AM-PAC “6-Clicks” basic mobility and daily activity scores with discharge destination. Physical therapy, 101(4), pzab043. https://doi.org/10.1093/ptj/pzab043. PMID: 33517463.

Weyer-Jamora, C., Brie, M. S., Luks, T. L., Smith, E. M., Hervey-Jumper, S. L., & Taylor, J. W. (2021). Postacute cognitive rehabilitation for adult brain tumor patients. Neurosurgery, 89(6), 945. https://doi.org/10.1093/neuros/nyaa552