Poster 24: Prognostic Indicators in Metastatic Spinal Cord Compression: Using FIM and Tokuhashi Scale to Optimize Rehabilitation Planning

Abstract

Objectives: To determine if patients with metastatic spinal cord compression (MSCC) make significant functional gains through rehabilitation; to study survival and predictors of survival in MSCC; and to explore predictive factors for high or low functional gains in MSCC. Design: Retrospective, descriptive study. Setting: Inpatient neuro-oncology rehabilitation ward, Henderson General Hospital, Hamilton, Canada. Participants: Clinical records were examined for 63 inpatients with MSCC. Main Outcome Measures: Demographics, treatment of MSCC, length of rehabilitation, admission, and discharge FIM scores, Tokuhashi score, and survival data were collected. Statistical analyses included nonparametric comparisons, Kaplan-Meier analyses, Cox regression, and exploratory logistic regression. Results: FIM score improved from 83 to 102 (P<.001). Estimated median survival from time of rehabilitation was 10 months. Kaplan-Meier analysis showed longer survival in patients with high Tokuhashi scores (9–15) compared to low scores (0–8) (P<.005); and high FIM change (413) compared to low FIM change (p13) (P<.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio [OR]¼=1.30, 95% confidence interval [CI]¼, 1.04–1.62), and length of rehabilitation (OR¼=1.04, 95% CI¼, 1.01–1.07) were associated with high FIM gain. Conclusions: Rehabilitation improves functional outcomes in MSCC. Patients who had a high Tokuhashi score and achieved high functional gains after rehabilitation had longer survival. Tokuhashi score and length of rehabilitation were associated with high FIM gain. The Tokuhashi score can help identify patients with good prognosis and potential for improvement during rehabilitation.