The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection Psychological intervention in young brain tumor survivors: The efficacy of the cognitive behavioural approach Traumatic brain injury rehabilitation: are there alternatives to randomized clinical trials? Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb. Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: a randomized, controlled trial Use of the International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in primary brain tumour in an Australian community cohort. Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services. Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Multidisciplinary rehabilitation in women following breast cancer treatment: a randomized controlled trial. Factors Affecting Recovery After Acoustic Neuroma Resection Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: a controlled clinical trial. Chemotherapy for high-grade glioma. Functional recovery of patients with brain tumor or acute stroke after rehabilitation: A comparative study Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies. Effects of Aerobic Interval Training on Cancer Patients' Functional Capacity
Objective : To compare the effect of early customized vestibular rehabilitation with general instructions in patients after acoustic neuroma surgery . Setting : Tertiary referral centre . Subjects : Fifty-three patients after surgery . Design : A prospect i ve assessor-blinded , r and omized controlled trial . Interventions : After stratification for age ( < 50 years ; ≥50 years ) , patients were r and omly allocated into groups receiving general instructions or customized vestibular rehabilitation protocol s for 12 weeks . Outcome measures : St and ing Balance Sum , Timed Up and Go test , T and em Gait and Dynamic Gait Index . Balance performance was assessed preoperatively , at discharge ( one week after surgery ) , three , six , nine , 12 , 26 and 52 weeks after surgery . Results and discussion : All subjects clearly improved within the first six weeks after surgery . However , older subjects receiving vestibular rehabilitation performed significantly ( P<0.05 ) better on st and ing balance , Timed Up and Go test and T and em Gait , when compared with the older group that received only general instructions . This effect persisted up to 12 weeks and also became apparent on the Dynamic Gait Index . In addition , the older vestibular rehabilitation group had better balance scores at 12 weeks when compared with their original preoperative scores ( P<0.05 ) . This pattern remained even up to one year after surgery ( P<0.05 ) . Conclusion : In patients over 50 , early vestibular rehabilitation facilitates recovery of postural control after acoustic neuroma surgery . Customized vestibular rehabilitation should be given in addition to general instructions that stress the need of exposure to movement . Retention of the early beneficial effects even one year after surgery stresses the importance of customized vestibular rehabilitation Purpose . Cognitive and behavioural therapy ( CBT ) is often used to treat behavioural and emotional disorders in children , and its efficacy has been described in several studies . As behavioural and emotional disorders are frequent sequelae in brain tumor survivors , the goal of this work is to describe the efficacy of a CBT intervention in the treatment of young brain tumor survivors . Methods . Forty young patients , aged 4–18 years , were included in the study . The treatment group , composed of 17 patients , received sessions of CBT . The Child Behaviour Checklist 4–18 ( CBCL/4–18 ) and the Vinel and Adaptive Behavioural Scales ( VABS ) were administered to parents at the beginning and at the end of the hospitalisation . The statistical significance of changes for clinical subjects during the CBT administration was estimated . Results . With regard to the CBCL/4–18 , the clinical group showed a significant advantage on the withdrawn , somatic complaints , social problems , attention problems , internalising and total problem scales . On the VABS , the treatment group improved to a significantly greater extent in the social skills domain . Conclusions . These results substantiate our assumption that CBT is an effective intervention for young patients surviving brain tumors and may be particularly helpful to younger individuals in managing cancer-related limitations R and omized clinical trials ( RCTs ) are widely considered to be the gold st and ard of evidence for treatment efficacy , but they have not been widely applied to rehabilitation or , more specifically , traumatic brain injury rehabilitation . Ethical , scientific , and re source factors may limit the application of RCTs . Thus , rigorous observational alternatives to the RCT would be of great value . In the article by Powell et al , an attempt to rigorously apply an observational design to assess the relative effectiveness of  inpatient rehabilitation  versus  home  discharge failed to control for important confounding factors . It appears nearly impossible to successfully apply observational design s when the factors leading to the applications of different treatments are strongly related to the patient 's perceived prognosis . However , observational design s may be successfully applied when regional or temporal variations in care are studied . Moreover , a number of developments in measurement , study design , and statistical analysis may exp and the role of observational studies in answering questions of rehabilitation efficacy and effectiveness OBJECTIVE To evaluate the effects of the intensive repetition of movements elicited by the facilitation technique to improve voluntary movement of a hemiplegic lower limb in patients with brain damage . DESIGN A multiple-baseline design ( A-B-A-B : A without specific therapy , B with specific therapy ) across individuals . PATIENTS The sample comprised 22 subjects with stroke and 2 brain tumour-operated subjects ( age : 50.7 + /- 9.6 years , time after onset : 7.1 + /- 2.6 weeks ) . They were selected from among 165 patients with stroke who were admitted to our rehabilitation centre from September 1 , 1995 to March 31 , 1997 . METHODS Two 2-week facilitation technique sessions ( more than 100 repetitions a day for each of 5 kinds of movement ) were applied at 2-week intervals in patients with hemiplegia , who were being treated with continuous conventional rehabilitation exercise without the facilitation technique for hemiplegia . Motor function of the affected lower limb ( Brunnstrom Recovery Stage of hemiplegia , the foot-tap test and the strength of knee extension/flexion ) and walking velocity were evaluated at 2-week intervals . RESULTS Significant improvements in Brunnstrom Stage , foot-tapping and the strength of knee extension/flexion of the affected lower limb were seen after the first conventional rehabilitation exercise session and after the first and second facilitation technique and conventional rehabilitation exercise sessions . The improvements after facilitation technique and conventional rehabilitation exercise sessions were significantly greater than those after the preceding conventional rehabilitation exercise sessions . CONCLUSION Intensive repetition of movement elicited by the facilitation technique ( chiefly proprioceptive neuromuscural facilitation pattern , stretch reflex and skin-muscle reflex ) improved voluntary movement of a hemiplegic lower limb in patients with brain damage PURPOSE Patients with gliomas often experience cognitive deficits , including problems with attention and memory . This r and omized , controlled trial evaluated the effects of a multifaceted cognitive rehabilitation program ( CRP ) on cognitive functioning and selected quality -of-life domains in patients with gliomas . PATIENTS AND METHODS One hundred forty adult patients with low- grade and anaplastic gliomas , favorable prognostic factors , and both subjective cognitive symptoms and objective cognitive deficits were recruited from 11 hospitals in the Netherl and s. Patients were r and omly assigned to an intervention group or to a waiting-list control group . The intervention incorporated both computer-based attention retraining and compensatory skills training of attention , memory , and executive functioning . Participants completed a battery of  neuropsychological  ( NP ) tests and self-report question naires on cognitive functioning , fatigue , mental health-related quality of life , and community integration at baseline , after completion of the CRP , and at 6-month follow-up . RESULTS At the immediate post-treatment evaluation , statistically significant intervention effects were observed for measures of subjective cognitive functioning and its perceived burden but not for the objective NP outcomes or for any of the other self-report measures . At the 6-month follow-up , the CRP group performed significantly better than the control group on NP tests of attention and verbal memory and reported less mental fatigue . Group differences in other subjective outcomes were not significant at 6 months . CONCLUSION The CRP has a salutary effect on short-term cognitive complaints and on longer-term cognitive performance and mental fatigue . Additional research is needed to identify which elements of the intervention are most effective Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients and exerts a deep negative impact on quality of life interfering with familiar , social and career-related activities . To test the effectiveness of early cognitive rehabilitation treatment for in patients affected by primary brain tumors . Out of 109 consecutive patients enrolled in the study , 58 patients were r and omly assigned to a rehabilitation group or to a control group . The rehabilitation consisted of 16 one-hour individual sessions of therapist-guided cognitive training , spread over 4 weeks , combining computer exercises and metacognitive training . Patients in the control group received usual care without cognitive training . All patients were evaluated by means of a comprehensive neuropsychological battery at the admission ( T0 ) and after 4 weeks ( T1 ) . Patients in the rehabilitation group showed a significant improvement of cognitive functions . In particular , the domains that benefited most from the training were visual attention and verbal memory . The control group exhibited only a slightly , not statistically relevant , enhancement of cognitive performances .  Cognitive rehabilitation for neuro-oncological in patients result ed in a significant enhancement of cognitive performances after the training , also providing a foundation for early administration . Future research should be aim ed to clarify the patients ’ characteristics that predict neuropsychological improvement , to identify the most effective elements in rehabilitative programs and to study the effects of treatment extension to everyday life OBJECTIVE To describe  patient-reported disability in primary brain tumours using the International Classification of Functioning , Disability and Health ( ICF ) ; and comparison with categories within the core sets for stroke and traumatic brain injury . METHOD A prospect i ve community cross-sectional survey ( n = 106 ) following definitive treatment for primary brain tumours . Problems reported by participants were linked with ICF categories using ' linkage ' rules . Participants rated  ' activities and participation '  and  ' environmental factor '  components of ICF checklist ( using qualifiers ) ; and responses compared with categories within core sets for stroke and traumatic brain injury . RESULTS Participant mean age 51 years , median time since diagnosis 2 years ; over a third had high grade tumours . Participants considered 44 categories in ' activities and participation ' and 16 categories ( barriers ) in ' environmental factors ' as relevant ( ≥ 10 % response ) using checklist . Reported problems included : Mobility , Domestic life , General tasks/ dem and s ; and Human made changes to environment . Although the linked categories for brain tumour survivors were similar to those in the core sets for stroke and traumatic brain injury , there was more commonality with the traumatic brain injury core set . CONCLUSION The existing comprehensive stroke and traumatic brain injury core sets incorporate issues relevant to brain tumour survivors in post-acute setting s. Findings from this report will assist in defining a future core set for brain tumour ; the possibility however , of using a single core set relevant to most long-term neurological conditions needs to be explored Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer . Despite the high incidence of neurological and functional deficits in patients affected by brain tumours ( BTs ) , rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions . To assess functional outcome in brain tumour in patients who underwent early rehabilitation after surgery . 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study . All patients were evaluated by means of a core set of clinical scales ( Functional Independence Measure , Sitting Balance score , St and ing Balance score , Hauser Index , Massachusetts General Hospital Functional Ambulation Classification ) . Patients were evaluated before the beginning ( T0 ) and at the end ( T1 ) of rehabilitation treatment . The neurorehabilitation programme consisted of individual 60-min sessions of treatment , administered once a day , six days a week , for four consecutive weeks . Speech therapy was included when aphasia was diagnosed . All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients ( P = 0.000 ) . Analysis of subgroups showed that patients affected by meningioma achieved better results ( in efficiency terms ) as regards independence in activities of daily living ( P = 0.02 ) and mobility ( P = 0.04 ) compared with patients affected by glioblastoma or stroke . Rehabilitation after surgery can improve functional outcome , justifying the delivery of rehabilitation services , even during the acute phase , to BTs in patients , irrespective of tumour type Purpose Physical exercise ( PE ) and /or therapy ( PT ) shows beneficial effects in advanced cancer patients and is increasingly implemented in hospice and palliative care , although systematic data are rare . This retrospective study systematic ally evaluated the feasibility of PE/PT in terminally ill cancer patients and of different modalities in correspondence to socio-demographic and disease- and care-related aspects . Methods All consecutive terminally ill cancer patients treated in a palliative care inpatient ward during a 3.5-year period were included . The modalities were chosen according to the therapists ' and patients ' appraisal of current performance status and symptoms . Results PE/PT were offered to 572 terminally ill cancer patients , whereof 528 patients ( 92 % ) were able to perform at least one PE/PT unit ( average 4.2 units/patient ) . The most frequently feasible modalities were physical exercises in 50 % , relaxation therapy in 22 % , breathing training in 10 % , and positioning and lymph edema treatment in 6 % each .  Physical exercise  and  positioning treatment were performed significantly more often in older patients ( p = 0.009 and p = 0.022 , respectively ) , while relaxation ( p = 0.05 ) and lymph edema treatment ( p = 0.001 ) were used more frequently in younger . Breathing training was most frequently performed in head and neck cancer ( p = 0.002 ) and lung cancer ( p = 0.026 ) , positioning treatment in brain tumor patients ( p = 0.021 ) , and lymph edema treatment in sarcoma patients ( p = 0.012 ) . Conclusions PE/PT were feasible in > 90 % of terminally ill cancer patients to whom PE/PT had been offered . Physical exercises , relaxation therapy , and breathing training were the most frequently applicable methods . Prospect i ve trials are needed to evaluate the efficacy of specific PE/PT programs in terminally ill cancer patients Data from the Aging with Disability ( AwD ) Study are used to examine variations in the types and frequency of secondary conditions experienced by 301 middle-aged individuals living with the effects of three disabling conditions : polio ( n = 124 ) , rheumatoid arthritis ( RA ) ( n = 103 ) , and stroke ( n = 75 ) . All respondents were r and omly selected from a county rehabilitation hospital or a community-based subject pool . Secondary conditions are operationalized as ( 1 ) the number of new health problems diagnosed or treated since the onset of the primary disability and ( 2 ) the amount of change/decline in basic and instrumental daily activities since a previous reference period in the disability trajectory . Also analyzed are changes in use of assistive devices and unmet needs for services . Differences in secondary conditions are examined within the AwD sample by impairment group and between sample s by comparing AwD rates to national estimates for the same cohort . Results reveal significant differences in the types of new health problems reported by persons living with polio , RA , and stroke and document marked disparities , or accelerated aging , between disabled and nondisabled adults . Findings are discussed in terms of the changing health care needs of persons aging with disability and the importance of improving access to preventive services , ongoing rehabilitation , and assistive technology OBJECTIVES To determine the relationship between functional outcome and quality of life ( QOL ) in patients with brain tumors receiving inpatient rehabilitation , and to assess the sensitivity of 4 assessment tools in measuring changes in that population . DESIGN Prospect i ve study using longitudinal data collected from consecutively admitted patients . SETTING Acute inpatient rehabilitation unit . PARTICIPANTS Ten patients with primary brain tumors admitted to an acute inpatient rehabilitation unit . INTERVENTIONS Patients participated in an inpatient interdisciplinary rehabilitation program that used the following disciplines : occupational therapy , rehabilitation therapy , recreational therapy , speech therapy , physical therapy , rehabilitation nursing and case management . MAIN OUTCOME MEASURES The FIM instrument , Disability Rating Scale ( DRS ) , Karnofsky Performance Status Scale ( KPS ) , Functional Assessment of Cancer Therapy-Brain ( FACT-BR ) . RESULTS Improvement in total functional outcome was indicated by all 3 functional measures ( FIM : F = 46.84 , p < .05 ; DRS : F = 19.25 , p < .05 ; KPS : F = 10.11 , p < .05 ) . Significant improvements were found between admission and discharge scores for the FIM and DRS . The KPS revealed significant improvement between admission and 3-month follow-up scores . All admission and discharge functional scales ( FIM , DRS , KPS ) correlated significantly with each other . No significant change was noted in the FACT-BR between admission and discharge scores , but FACT-BR scores did improve at 1- and 3-months postdischarge relative to admission . The FIM , KPS , and DRS did not show significant correlation with the FACT-BR . Ninety percent of patients were initially discharged to a home environment . CONCLUSION Although patients make functional gains during and after inpatient rehabilitation , gains in QOL are not significant until 1 month postdischarge . QOL does not appear to correlate well with functional outcomes . Further , the KPS is less sensitive than the FIM and DRS in detecting change in functional status OBJECTIVE To assess the effectiveness of a multidisciplinary ambulatory rehabilitation programme for women following definitive breast cancer treatment in an Australian community cohort . METHODS Eighty-five women in the community r and omized to a  treatment group ( n = 43 ) for individualized high-intensity programme , or a control group ( n = 42 ) comprising usual activity . The primary outcome Depression Anxiety Stress Scale ( DASS ) scale measured restriction in participation . Secondary measures included Perceived Impact Problem Profile ( PIPP ) and Cancer Rehabilitation Evaluation System Short-Form ( CARES-SF ) ; and Functional Independence Measure ( FIM ) motor subscale for activity limitation . Assessment s were at baseline and 4 months . RESULTS Intention-to-treat analysis of data showed a significant difference between both groups in DASS Depression scores ( p = 0.006 ) ( moderate effect size , r > 0.3 ) , PIPP Mobility ( p = 0.05 ) and Participation ( p = 0.04 ) scales , and CARES-SF Global score ( p = 0.02 ) ( small effect size , r < 0.3 ) . The treatment group , compared with control group , showed significant improvement in the DASS Depression scores : 22/42 ( 52.4 % ) vs 12/37 ( 32.4 % ) ( p = 0.02 ) . No difference between groups was noted in the FIM scale . CONCLUSION Rehabilitation can benefit participation in breast cancer survivors . Evidence for specific rehabilitation interventions is needed . Integrated cancer programmes allow opportunities to evaluate patients in various setting s , but require outcome research to develop service models for survivorship issues In order to determine which variables influence recovery from acoustic neuroma resection , acutely postoperative patients were divided into two groups and treated twice daily at bedside as in patients at a tertiary care center . Treatment times were increased gradually from 5 to 30 min . Exercise subjects underwent passive and active head movements and walking with augmented head movements . Control subjects received attention without exercise . Pre- and post-tests included vertigo intensity and frequency , low-frequency vestibulo-ocular reflex ( VOR ) , posturography and path integration . Post-tests were given at discharge and at , 4-week intervals for 3 months . Multilevel statistical analyses showed that neither group assignment nor age affected the outcome . All measures were abnormal at discharge but improved towards normal within 3 weeks . VOR on the unoperated side returned to normal values but on the lesioned side did not . Therefore , compensation is influenced by tumor size but not by age or early postoperative vestibular rehabilitation . Most compensation occurs within 3 weeks , probably due to central mechanisms , although some measures may not recover completely PURPOSE The primary goal of this study was to evaluate the feasibility and effectiveness of a structured , multidisciplinary intervention targeted to maintain the overall quality of life ( QOL ) , which is more comprehensive than psychosocial distress , of patients undergoing radiation therapy for advanced-stage cancer . PATIENTS AND METHODS Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0 % to 50 % were r and omly assigned to either an eight-session structured multidisciplinary intervention arm or a st and ard care arm . The eight 90-minute sessions addressed the five domains of QOL including cognitive , physical , emotional , spiritual , and social functioning . The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale ( Linear Analog Scale of Assessment or modified Spitzer Uniscale ) . QOL was assessed at baseline , week 4 ( end of multidisciplinary intervention ) , week 8 , and week 27 . RESULTS Of the 103 participants , overall QOL at week 4 was maintained by the patients in the intervention ( n = 49 ) , whereas QOL at week 4 significantly decreased for patients in the control group ( n = 54 ) . This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group ( P = .009 ) . Intervention participants maintained their QOL , and controls gradually returned to baseline by the end of the 6-month follow-up period . CONCLUSION Although intervention participants maintained and actually improved their QOL during radiation therapy , control participants experienced a significant decrease in their QOL . Thus , a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment OBJECTIVE To evaluate effectiveness of a multidisciplinary rehabilitation program for persons following definitive primary brain tumour treatment in a community cohort . METHODS The brain tumour ( glioma ) survivors ( n = 106 ) were allocated either to the treatment group ( n = 53 ) ( intensive ambulatory multidisciplinary rehabilitation ) , or the waitlist control group ( n = 53 ) . The primary outcome - Functional Independence Measure ( FIM ) , measured ' Activity ' limitation ; secondary measures included Depression , Anxiety Stress Scale , Perceived Impact Problem Profile and Cancer Rehabilitation Evaluation System . Assessment s were at baseline , 3 and 6 months after program completion . RESULTS Participants were predominantly women ( 56 % ) , with mean age 51 years ( st and ard deviation 13.6 ) and median time since diagnosis of 2.1 years . Intention-to-treat analysis showed a significant difference between groups at 3-month in favour of multidisciplinary rehabilitation program in FIM motor subscales : ' self-care ' , ' sphincter ' , ' locomotion ' , ' mobility'(p < 0.01 for all ) ; and FIM ' communication ' ( p < 0.01 ) and ' psychosocial ' subscales ( p < 0.05 ) , with small to moderate effect size ( r = 0.2 - 0.4 ) . At 6-month follow-up , significant improvement in the treatment group was maintained only for FIM ' sphincter ' , ' communication ' and ' cognition ' subscales ( p < 0.01 for all ) . No difference between groups was noted in other subscales . CONCLUSIONS brain tumour survivors can improve function with multidisciplinary rehabilitation , with some gains maintained up to 6 months . Evidence for specific interventions in the ' blackbox ' of rehabilitation is needed Background Trials on the effect of systemic chemotherapy on survival and recurrence in adults with high- grade glioma have had inconclusive results . We undertook a systematic review and meta- analysis to assess the effects of such treatment on survival and recurrence . Objectives To compare radiotherapy plus chemotherapy with radiotherapy alone in completely resected adults with high- grade glioma . To investigate whether or not pre-defined patient subgroups benefit more or less from chemotherapy . Search methods MEDLINE and CancerLit search es were supplemented with information from trial registers and by h and search ing relevant meeting proceedings and by discussion with relevant trialists and organisations . These search es were carried out in June 1997 , June 1999 , December 2000 and August 2003 . Selection criteria Trials comparing radiotherapy versus radiotherapy + chemotherapy were eligible for inclusion provided that they r and omized adult patients using a method which precluded prior knowledge of treatment assignment . Data collection and analysis A quantitative meta- analysis using up date d information from individual patients from all available r and omized trials was carried out . Data from all patients r and omized in all eligible trials were sought directly from those responsible . Up date d information on survival and date of follow-up were obtained , as were details of treatment allocation , date of r and omization , age , sex , histological cell type , stage and performance status . To avoid potential bias , information was requested for all r and omized patients including those who had been excluded from the investigators ' original analyses . All analyses were done on an intention to treat basis on the endpoint of survival . For trials using cisplatin-based regimens , subgroup analyses by age , sex , histological cell type , tumour stage and performance status were also done . Main results Data from 12 r and omized trials and 3004 patients were included . The results show a significant prolongation of survival associated with chemotherapy , with a hazard ratio of 0.85 ( 95 % CI 0.78 - 0.91 , p=0.00004 ) or 15 % relative decrease in the risk of death . This is equivalent to an absolute increase in one year survival rate of 6 % ( 95 % confidence interval 3 % to 9 % ) from 40 % to 46 % and a two-month increase in median survival time ( 95 % confidence interval one month to three months ) . There was no evidence that the effect of chemotherapy  was different in any group of patients defined by age , sex , histology , performance status or extent of resection . Authors ' conclusions This small but clear improvement in survival from chemotherapy encourages further study of drug treatment of these The aim of this study was to compare the locomotor functional recovery of patients with brain tumor and patients with stroke . Each patient with a brain tumor was matched to a patient with stroke according to the lesion side . Twenty-one patients operated for intracranial tumors and 21 patients with stroke were studied . The mean ages ( + /- st and ard deviation ) of patients were 52.5+/-16 years for patients with brain tumor and 56.7+/-11 years for patients with stroke . For each patient , the age , gender , presence of aphasia , smoking habit , co-morbidities , lesion origin and lesion size ( for the brain tumor group ) were recorded . Locomotor and functional recovery were evaluated by using the Postural Assessment Scale for Stroke , the Berg Balance Scale , Motor Assessment Scale and the mobility section of the Functional Impairment Measure . There was no difference regarding demographic characteristics between the two groups . After rehabilitation both groups had significantly improved in terms of all parameters , but the extent of improvement did not differ between the two groups Sound rigorous methods are needed by research ers and providers to address practical questions about risks , benefits , and costs of interventions as they occur in routine clinical practice such as : Are treatments used in daily practice associated with intended outcomes ? For whom does an intervention work best ? With limited clinical re sources , what are the best interventions to use for specific types of patients ? Answers to such questions can help clinicians , patients , research ers , and health care administrators learn from , and improve , real-world everyday clinical practice . In this article , we describe existing research design s to demonstrate clinical usefulness and comparative effectiveness of  rehabilitation treatments .  We compare r and omized controlled trials and observational cohort studies of various types , including those that use instrumental variables or propensity scores to control for potential patient or treatment selection effects . We argue that practice -based evidence ( PBE ) study design s include features that address limitations inherent in both r and omized trials and traditional observational studies , and also reduce the need for instrumental variables and propensity scores methods . We give examples of how PBE design s have been used in various rehabilitation areas to determine better treatments for specific types of patients The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity ( VO2Lmax ) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied . Subjects were stratified by baseline functional capacity ( ± 1 MET ) and r and omized to experimental ( EX ) , placebo ( PL ) , and control ( CO ) groups . EX subjects completed a 10-week , 3 times/week exercise training program ; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises ; the CO group maintained normal activities . The EX group showed significant , p < .05 , improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups . The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy
BACKGROUND Brain tumours can cause significant disability , which may be amenable to multidisciplinary rehabilitation .
However , the evidence base for this is unclear .
No. CD009509 ] on ' Multidisciplinary rehabilitation after primary brain tumour treatment ' .
OBJECTIVES To assess the effectiveness of multidisciplinary rehabilitation in people after primary brain tumour treatment , especially the types of approaches that are effective ( setting s , intensity ) .