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  • Title: Metastatic paraplegia and vital prognosis: perspectives and limitations for rehabilitation care. Part 1.
    Author: Fattal C, Fabbro M, Gelis A, Bauchet L.
    Journal: Arch Phys Med Rehabil; 2011 Jan; 92(1):125-33. PubMed ID: 21187215.
    Abstract:
    OBJECTIVE: To evaluate the vital prognosis of patients with metastatic epidural spinal cord compression (MESCC) to determine the relevance and duration of physical medicine and rehabilitation (PM&R) admission. DATA SOURCES: Publications from 1980 to January 2010 selected from 3 databases. STUDY SELECTION: Publications reporting data correlated with survival and prognosis factors, highlighting publications with level A scientific evidence (prospective randomized controlled studies with significant casuistry and relevant judgment criteria). The work focused on patients with MESCC below T1. DATA EXTRACTION: Standardized reading grid. DATA SYNTHESIS: Thirty-eight studies met the inclusion criteria. Most were retrospective. For survival rate at 1 year, they reported data ranging from 12% to 58%. The 12-month and median survival rates were the data reported most often in the articles. The median survival rate ranged from 2.4 to 30 months, and 12-month survival rates ranged from 12% to 58%. Of publications that chose this parameter, 95% reported 12-month survival rates less than 55.2% (95th percentile) regardless of patients' functional status and associated risk factors (eg, location of primary cancer, metastases spreading, pretreatment ambulatory status). CONCLUSIONS: Despite major progress in cancer care, patients with MESCC still have a limited vital prognosis. The relevance and duration of PM&R care must be evaluated against the patient's functional need for rehabilitation while making time for family. The hypothesis of a 1-month stay extended only once appears reasonable for patients to adapt to their new functional status without taking precious time away from their loved ones.
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