Factors influencing activities of daily living using FIM–FAM scoring system before starting adjuvant treatment in patients with brain tumors: results from a prospective study

Abstract

Patients with brain tumors have varied degree of functional and psychological impairments because of factors relating to the tumor or to the treatment they receive. The functional independence measurement and functional activity measurement system (FIM-FAM) is an activity of daily living (ADL) scoring system that may be able to determine impairments in different domains objectively. From August 2007 to April 2008, 150 consecutive adult (>18 years) primary brain tumor patients (median age 40 years; male 88, female 62) registered in a general out-patient neuro-oncology clinic were accrued and detailed data were recorded. Seventy percent had malignant tumor (66% high-grade and 34% low-grade; 70% intra-axial). Glioblastoma (GBM) (23.3%), anaplastic astrocytoma (AA) (18.7%), and diffuse fibrillary astrocytoma (18.7%) were the commonest histologic subtypes. The common sites for tumors included frontal region (30.7%), posterior fossa (12%), and left parietal region (11.3%). A detailed baseline pre-radiotherapy (pre-RT) ADL assessment was done with the FIM-FAM scoring system, which has seven domains with 30 sub-domains (maximum and minimum total scores are 210 and 30). The mean total FIM-FAM score of the entire patient population was 167.5 (range 30-208). Scores in self care, sphincter control, mobility items, locomotion, communication items, psychological, and cognitive item domains were 39.49, 10.95, 22.70, 16.44, 28.93, 18.96, and 30.1, respectively. Univariate analysis showed total FIM-FAM scores not significantly different with age (< or =35 years vs. >35 years; P = 0.994), sex (male versus female; P = 0.133), and grade of the tumor (high-grade versus low-grade; P = 0.142) but were significantly higher in patients with a Karnofsky performance score (KPS) of > or =70 as compared with <70 (P = 0.001), neurological performance scale (NPS) of 0 or 1 vs. 2 or 3; P = 0.001), disease type (benign versus malignant; P = 0.001), and site of disease (cerebral versus cerebellar; P = 0.024). Multivariate analysis confirmed these findings for KPS (P = 0.001) and NPS (P = 0.012) only. Age was a significant factor for poorer cognitive function (P = 0.005), psychological (P = 0.045), and self care function (P = 0.001). A trend for correlation between tumor sites with the corresponding function as assesses on the FIM-FAM score was observed. Mobility domain scores were poor for left parietal domain and psychosocial for frontal lobe lesion. Pearson correlation test demonstrated a significant correlation between KPS and NPS with FIM-FAM scores (P = <0.001). Average time to perform the FIM-FAM was 15-20 min. FIM-FAM system is relatively simple, easy to perform in routine clinical practice and may be used as a tool for assessment of rehabilitation program. There is strong correlation with age, type of tumor, and site of disease with different functional and cognitive domain impairment.