Long-term patient rehabilitation and quality of life after oncological endoprosthesis of long bones and joints

Abstract

Background. Currently, endoprosthesis of large bones and joints is the standard of treatment for patients with tumors in the bones and joints of the upper and lower limbs and pelvis. However, the problem of integrated medical rehabilitation of these patients remains unsolved. In the postoperative period, patients frequently experience such functional abnormalities as limited mobility in the operated joint, pain, deceased locomotor activity in the joints due to prolonged bedrest leading to muscle hypotrophy. These abnormalities interfere with return to full social life affecting patients’ quality of life and making rehabilitation very important. Aim. To evaluate the effect of rehabilitation on patients’ quality of life and social adaptation after oncological endoprosthesis. Materials and methods. The study included 57 patients: 27 (47 %) males and 30 (53 %) females. Mean age was 46 years (19–71 years). In 10 patients, tumors were localized in the bones of the upper limb; in 6 patients, in the pelvic bones; in 41 patients, in the bones of the lower limb. Tumor volume varied between 24 and 3,783 cm3 (median 631 cm3 ). Pathological fractures were observed in 13 (24.5 %) patients, their risk – in 13 (24.5 %) patients. Patient activization was started at day 1–14 after surgery, passive working out of the operated limb on day 2–14. For quality of life evaluation, The Short Form-36 (SF-36) was used allowing to determine patients’ health. Functional results were analyzed using the Musculoskeletal Tumour Society score (MSTS), rehabilitation potential using the Tampa Scale of Kinesiophobia covering both physical and psychological components. Social status was evaluated based on patient’s occupation and social adaptation. Results. Performance of active rehabilitation activities after onco-orthopedic intervention allows 72 % of patients to achieve good and excellent functional results per the MSTS scale (60–97 %) under condition of protective regimen observation, as well as positively affects physical and psychological parts of quality of life. Use of Tampa Scale of Kinesiophobia allows to correct psychological and/or physical parts of kinesiophobia in a timely fashion. Adequately performed rehabilitation allows 46 % of patients to remain socially active, continue working. Conclusion. Scale of surgical intervention, presence of pathological fracture, as well as postoperative complications, affect both functional results and quality of life of patients which in this period in most observations is higher than prior to onco-orthopedic treatment. Tampa Scale of Kinesiophobia allows to evaluate patient motivation towards postoperative recovery and provide psychological help in a timely manner which decreases rehabilitation time.