Brain tumour rehabilitation guidelines
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Table V. Recommendations for rehabilitation interventions in the clinical practice guidelines
Level of evidence
NICE,
Rehabilitation interventions 2006 (26) ACN,
2009 (25)
Multidisciplinary rehabilitation with individually settled goals
Physiotherapy intervention
Occupational therapy
Aerobic training (no specific recommendation, timing and intensity must be in
accordance with patient’s goals and status)
Resistance training (no specific recommendation, timing and intensity must be in
accordance with patient’s goals and status)
Neuropsychological assessment
Psychotherapy/psychological support
Cognitive behavioural therapy
Relaxation therapy to reduce stress and anxiety
Speech therapy for swallowing disorders
Speech therapy for problems with communications
Compensatory aid recommendation (for mobility, special equipment for home setting)
Education-provide specific information about disease and treatment for patients and
their families and carers Recommended without evidence
Recommended without evidence
Recommended without evidence
Not reported III*
III
III
Recommended without evidence
Not reported Recommended without evidence
Recommended
Recommended
Not reported
Not reported
Recommended
Recommended
Recommended
Recommended
without evidence
without evidence
without
without
without
without
evidence
evidence
evidence
evidence
IV
I
I
II
III
III
Recommended without evidence
I
*Based on National Health and Medical Research Council (NHMRC), Australia guidelines.
NICE: National Institute for Health and Clinical Excellence; ACN: Australian Cancer Network.
strength and endurance. However, no specific recom-
mendations with regards to timing, dose and intensity
are provided. ACN advocates for resistance training
of unaffected muscles to compensate for impaired
coordination for those with ataxia and cerebellar dys-
function. There is no description of exercise therapy
in the NICE guidelines.
Neuropsychological management. ACN recommends
neuropsychological assessment for behavioural chan-
ges, and organic personality change in patients with
BT for cognitive deficits. It recommends that depres-
sion and anxiety can interfere with a person’s capacity
to make treatment decisions and should be treated
with a combination of psychotherapy and cognitive
behavioural therapy, together with relaxation therapy
or guided imaginary to help deal with stressful situa-
tions. The NICE guidelines recommend psychological
assessment and support as an integral part of compre-
hensive care; however, the guidelines fail to provide
any specific description or evidence.
Communication and swallowing. Speech and language
therapy are offered to those with communication and/
or swallowing dysfunction, for aspiration intervention
and adjustments to food consistency. However, NICE
only mentions involvement of a speech therapist as a
part of the rehabilitation team, without specific recom-
mendations or evidence.
Compensatory aids. Both NICE and ACN recommend
immediate access to specific orthoses (ankle-foot
orthoses), walking sticks or walkers, and wheelchairs
for BT patients with gait impairment. Neither of the
2 CPGs provides specific recommendations and/or
level of evidence.
DISCUSSION
This review comprehensively evaluates and assesses
the methodological quality of the published CPGs for
management of BT and summarizes recommendations
for applicability from the rehabilitation perspective.
Despite the challenges and complexity of delivering
healthcare to BT survivors, there is well-documented
evidence advocating the integral role of rehabilitation
(10, 11) in restoring function, minimizing complications,
reducing morbidity and improving QoL (9, 27–29). This
review identifies several CPGs for the management of
BT published in the last decade. However, majority
focus on acute radiological, surgical and medical tre-
atments, and rehabilitation approaches are neglected.
Of the 11 published CPGs identified, only 2 provide
recommendations for rehabilitation interventions. Both
of these CPGs (published by NICE and ACN) describe
rehabilitation approaches ambiguously and provide limi-
ted information about various rehabilitation modalities.
With improved survival of patients with cancer, the role
of rehabilitation must be emphasized.
Comparison between the guidelines
The overall quality of the included 2 CPGs was “mo-
derate”. Despite increasing evidence for rehabilitation
in improved physical (6, 9, 28), psychosocial wellbeing
and QoL (7, 29, 30), the included CPGs failed to incor-
porate and provide detailed evidence-based informa-
tion on many specific rehabilitation recommendations.
The overall recommendations in the NICE guidelines
on rehabilitation approaches is too generic, failing to
provide specific description and a supporting body of
evidence behind the recommendations. Only the ACN
J Rehabil Med 51, 2019