Original Research The Impact of Inpatient Rehabilitation on Function and Survival of Newly Diagnosed Patients With Glioblastoma Pamela S. Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, Miriam Nuño, PhD, Dale Sherman, PhD, Arash Asher, MD, Jeffrey Wertheimer, PhD, Richard V. Riggs, MD, Chirag G. Patil, MD, MS Objective: To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor. Design: A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013. Setting: An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation. Participants: Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation. Main Outcome Measurements: Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program. Results: A total of 89 patients (93.7%) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8%), followed by self-care (88.4%), communication/social cognition (75.8%), and sphincter control (50.5%). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient reha- bilitation (P ¼ .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P ¼ .16). Among the patients who underwent inpatient rehabilitation, older age (HR, 2.24; P ¼ .0006), a low degree of resection (HR, 1.67; P ¼ .02), and lack of a Stupp regimen (HR, 1.71; P ¼ .05) were associated with greater hazard of mortality. Conclusions: Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multi- variate analysis showed no survival difference between patients who did and did not un- dergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis. PM R 2014;-:1-8 INTRODUCTION Glioblastoma multiforme (GBM) is the most common primary brain cancer and among the most lethal, accounting for approximately 1% of all cancer diagnoses and 2% of cancer deaths in the United States [1]. The number of new diagnoses made annually is 2-3 per 100,000 people in the United States and Europe. GBM accounts for 12%-15% of all intracranial tumors and 50%-60% of astrocytic tumors. The median survival of patients with GBM even after optimal treatment continues to be less than 15 months [2]. Patients with brain tumors who undergo inpatient rehabilitation have demonstrated functional improvements across multiple diagnostic categories, including GBM, astrocytoma, P.S.R. Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, 8631 West Third St, Suite 915 East, Los Angeles, CA 90048. Address correspondence to: P.S.R.; e-mail: pamela.roberts@cshs.org Disclosure: nothing to disclose M.N. Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose D.S. Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose A.A. Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose J.W. Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose R.V.R. Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose C.G.P. Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA Disclosure: nothing to disclose Submitted for publication February 16, 2013; accepted December 18, 2013. PM&R 1934-1482/13/$36.00 Printed in U.S.A. ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. -, 1-8, --- 2014 http://dx.doi.org/10.1016/j.pmrj.2013.12.007 1