Robert Ślusarz - Advances in Clinical and Experimental Medicine

ORIGINAL PAPERS
Adv Clin Exp Med 2007, 16, 5, 663–667
ISSN 1230−025X
© Copyright by Silesian Piasts
University of Medicine in Wrocław
ROBERT ŚLUSARZ
Early Assessment of Functional Capacity
in Patients After Brain Neoplasm Surgery
Wczesna ocena wydolności funkcjonalnej chorych
po operacji guza nowotworowego mózgu
Neurological and Neurosurgical Nursing Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus
University in Torun, Poland
Abstract
Background. Brain tumors pose a great therapeutic problem because they often lead to disorders of basic func−
tions and disability.
Objectives. The aim of this study was to assess functional capacity in patients after brain tumor surgery, determine
the areas of functional capacity deficits on the day of discharge, and check whether there is a correlation between
individual patients’ assessment scales.
Material and Methods. The study was conducted at a university neurosurgery and neurotraumatology clinic and
department and involved 46 patients who had had brain tumor surgery. Both observation and numerical scoring
were used. The Functional Capacity Scale, Karnofsky Performance Scale, “Repty” Functional Index, and the Glasgow
Outcome Score were used.
Results and Conclusions. At discharge, most patients were independent with regard to functional capacity. Some
deficits were observed with regard to satisfying physiological needs, personal hygiene activities, and experiencing
considerable pain. The assessment scales significantly correlated with one another (Adv Clin Exp Med 2007, 16,
5, 663–667).
Key words: functional capacity, brain tumor.
Streszczenie
Wprowadzenie. Guzy mózgu są dużym problemem terapeutycznym, ponieważ najczęściej powodują zaburzenia
podstawowych dla życia funkcji oraz różnego stopnia kalectwo.
Cel pracy. Ocena wydolności funkcjonalnej chorych po leczeniu operacyjnym guza mózgu, określenie obszarów
deficytu wydolności funkcjonalnej w dniu wypisu z oddziału oraz sprawdzenie, czy istnieje korelacja między po−
szczególnymi skalami służącymi do oceny stanu chorego.
Materiał i metody. Badania przeprowadzono w Katedrze i Klinice Neurochirurgii i Neurotraumatologii CM UMK,
na grupie 46 chorych operowanych z powodu guza mózgu. W badaniach zastosowano obserwację bezpośrednią z wy−
korzystaniem pomiaru. W badaniach posłużono się Skalą Wydolności Funkcjonalnej – FCS, skalą Karnofsky’ego
– KPS, wskaźnikiem funkcjonalnym „Repty” – FIR oraz skalą Glasgow wyników końcowych – GOS.
Wyniki i wnioski. Znaczna większość badanych w dniu wypisu z oddziału wykazywała samodzielność w zakre−
sie wydolności funkcjonalnej. Deficyt dotyczył jedynie takich obszarów, jak: samodzielne zaspokajanie potrzeb fi−
zjologicznych, samodzielne wykonywanie czynności higienicznych oraz odczuwanie znacznego stopnia dolegli−
wości bólowych. Zastosowane skale do oceny stanu chorego znacząco korelują ze sobą (Adv Clin Exp Med 2007,
16, 5, 663–667).
Słowa kluczowe: wydolność funkcjonalna, guz mózgu.
In neurology and neurosurgery, every exten−
sive intracranial process, both neoplastic (e.g. glio−
mas and meningiomas) and non−neoplastic
(e.g. brain abscess or arachnoid cyst), is consid−
ered a brain tumor [1, 2]. Brain tumors pose a great
therapeutic problem because they often lead to dis−
orders of basic functions and to disability [3, 4].
Therefore, although they rarely metastasize, brain
664
R. ŚLUSARZ
tumors are a serious threat to human life and in
most cases cause disability [5, 6]. A nervous−sys−
tem neoplasm reduces a patient’s functional
capacity [7]. The aim of this study was to assess
functional capacity in patients after brain tumor
surgery, determine the areas of functional capacity
deficit on the day of discharge, and check whether
there is a correlation among individual patients’
assessment scales.
Material and Methods
The study was conducted at the Neurosurgery
and Neurotraumatology Clinic and Department,
Collegium Medicum in Bydgoszcz, Nicolaus Co−
pernicus University in Torun, and involved 46 pa−
tients who had undergone brain tumor surgery.
Among the 46 patients were 23 men (50%). The
patients were between 19 and 64 years old.
Nineteen patients (41%) were between 41 and
60 years old. The mean age of all 46 patients was
50.4 ± 16.8 years.
The criteria for inclusion in the study were:
patients with brain neoplasm situated supratentori−
ally in the hemispheres, patients who had never
been operated on before, and patients who were
conscious on admission (capable of making logi−
cal verbal contact) and without significant neuro−
logical deficits. Criteria for exclusion were:
patients with brain neoplasm situated subtentorial−
ly or in brain ventricles, patients who had had
more than one operation or radiotherapy/chemio−
therapy, and patients who were not fully conscious
on admission (were not capable of making logical
verbal contact).
All tumors were situated supratentorially in
the hemispheres, i.e. in the frontal area (10 tumors,
21.7%), parietal area (10 tumors, 21.7%), tempo−
ral lobe (3 tumors, 6.5%), occipital lobe (11 tu−
mors, 23.9%), in two lobes (11 tumors, 23.9%),
and in three lobes (1 tumor, 2.2%). Most tumors
were of neuroepithelial origin (gliomas, 30 tu−
mors, 65.2%), some were metastatic (9 tumors,
19.6%), and some were meningeal (meningiomas,
7 tumors, 15.2%). Of all the primary tumors
(gliomas and meningiomas), 15 (40.6%) were
grade I according to the WHO system [8],
14 (37.8%) were grade II, 4 (10.8%) were grade
III, and 4 (10.8%) were grade IV. In the clinical
assessment on admission, the patients received
15 points on the Glascow Coma Scale. During
neurological examination before the operation, no
significant focal neurological deficits were
observed. All patients complained of headaches,
33 (71%) assessing their pain as severe (8 points
on the Visual Analogue scale).
All patients underwent an operation of com−
plete or partial removal of the tumor by means of
craniotomy. Patients operated on for gliomas
(grades III and IV) and metastatic tumors were
additionally subjected to radiotherapy.
Because the sample size was low, no statisti−
cally significant relations were found between the
patients’ functional capacity and clinical (histolog−
ical kind of tumor, malignancy degree, clinical pic−
ture) or sociodemographic factors (age, gender).
Procedure
The study was conducted by direct observa−
tion and measurement. The Functional Capacity
Scale (FCS) was used for early postoperative
assessment of functional capacity [9, 10]. This
scale allows one to recognize the patient’s abilities
in the particular clinical condition in the range of
functional outcome as well as the patient’s depen−
dence on the nursing staff, which is equal to defin−
ing a deficit in the particular marker. The scale has
12 markers: ambulation, alimentation, personal
hygiene, physiological needs, life functions mea−
surement, GCS, breathing, diagnosis, pre− and
post−surgical treatment, dressing and drainage,
acuteness of pain, pharmacotherapy, and neu−
ropsychologic outcome. To compare functional
capacity and final outcome of surgery, patients
were also assessed according to the KPS
(Karnofsky Performance Scale) [11], the FIR
(Functional Index ‘Repty’) [12], and the GOS
(Glasgow Outcome Scale) [13].
The consent of the Bioethics Commission of
Nicolaus Copernicus University in Torun,
Collegium Medicum in Bydgoszcz, was obtained
for the study. On arrival, each patient gave written
consent to the procedure.
Statistical Analysis
The results were calculated using MICROSOFT
EXCEL 2000 and STATISTICA v. 5.1. Correlation
was calculated using Spearman’s rank correlation
coefficient (rs). Statistical hypotheses were verified
according to a significance level of p < 0.001.
Results
On the day of discharge, patients classified in
group I of the FCS (40 persons, i.e. 87.0%) were
dominant (Table 1). This means that this was
a self−sufficient population (did not require assis−
tance from the nursing personnel). The average
number of points on the FCS was 43.7 ± 3.5. None
of the surveyed people were classified in group IV
665
Functional Capacity After Brain Neoplasm Surgery
Table 1. Functional capacity on the day of discharge assessed using the FCS
Tabela 1. Wydolność funkcjonalna chorego w dniu wypisu z oddziału oceniana za pomocą SWF
SWF (FCS)
N
I
II
III
IV*
40
5
1
0
independence, a self−sufficient patient (samowystarczalny/niezależność)
moderate independence, patient needs help (wymaga pomocy/niewielka zależność)
moderate dependence, patient needs significant help (wymaga dużej pomocy/znaczna zależność)
dependence, the patient needs intensive care (wymaga intensywnej opieki/zależność całkowita)
%
87.0
10.9
2.1
0
Razem (Total)
46
100
Average number of points in the scale ± standard deviation
(Średnia liczba punktów w skali ± odchylenie standardowe)
43.7 ± 3.5
* Value excluded from the calculation due to a lack of cases.
* Wartość pominięta w obliczeniach ze względu na brak przypadków.
of the FCS (totally dependent patients, requiring
intensive care from other people).
The patients’ functional capacity deficits
involved first of all such fields as satisfying own
physiological needs [4] (5 patients, 10.9%, group
IV), maintaining own body hygiene by oneself [3]
(5 patients, 10.9%, group III), and feeling intensi−
fication of pain to a significant extent [10]
(6 patients, 13.0% group III). The least extent of
deficiency was found in breathing [6] (46 people,
100.0%, group I) and measurement of vital func−
tions [5] (46 people, 100.0% group I) (Table 2).
The scales for the assessment of a patient’s
functional capacity and final assessment of treat−
ment results were verified (Table 3). The high, sta−
tistically significant (p < 0.001) values of
Spearman’s rank coefficient (rS = 0.78) for the cor−
relation between FCS and FIR result from the sim−
ilarity in the structure of these scales. FCS compo−
nents are similar to FIR components and both
scales classify patients into four groups. In the
case of the GOS and KPS, the correlation coeffi−
cients were lower, but also statistically significant.
Discussion
A survey conducted on a group of 40 patients
with diagnosed brain tumor [14] showed that on
discharge, most of the patients (80%) were classi−
fied into group I of functional capacity (minimal
care required from other people), and 2% were
classified to group IV (intensive care). It was also
found that the patients required minimal care in
such fields as moving about, maintaining body
hygiene, and relieving themselves. In a study by
Table 2. Functional capacity deficit on the day of discharge
Tabela 2. Deficyt wydolności funkcjonalnej chorego w dniu wypisu z oddziału
Indications for nursing (Wyznaczniki opieki)
Care group (Grupa opieki)
I
N
1. Ambulation (Poruszanie się)
28
II
%
60.9
III
N
%
N
14
30.4
4
IV
%
8.7
N
%
0
0
2. Alimentation (Odżywianie)
41
89.1
4
8.7
1
2.2
0
0
3. Personal hygiene (Czynności higieniczne)
30
65.2
11
23.9
5
10.9
0
0
4. Physiological needs (Potrzeby fizjologiczne)
28
60.9
12
26.1
1
2.2
5
10.9
5. Life functions measurement, GCS
(Pomiar czynności życiowych GCS)
46
100
0
0
0
0
0
0
6. Breathing (Oddychanie)
46
100
0
0
0
0
0
0
7. Diagnosis (Diagnostyka)
41
89.1
4
8.7
1
2.2
0
0
8. Pre− and post−surgical treatment
(Przygotowanie do zabiegu i opieka po)
37
80.4
9
19.6
0
0
0
0
9. Dressing and drainage (Opatrunki, drenaż)
38
82.6
8
17.4
0
0
0
0
10. Acuteness of pain (Stopień nasilenia bólu)
19
41.3
21
45.7
6
13.0
0
0
11. Pharmacotherapy (Farmakoterapia)
25
54.3
18
39.1
3
6.5
0
0
12. Neuropsychological outcome (Stan psychiczny)
10
21.7
34
73.9
2
4.3
0
0
666
R. ŚLUSARZ
Table 3. Patients’ functional capacity on the day of discharge
Tabela 3. Wydolność funkcjonalna chorego w dniu wypisu
Group (Grupa)
Measurement scale (Skala pomiarowa)
FCS/SWF
N
I
II
III
IV*
5
4
3
2**
1**
Total (Razem)
GOS
%
40
5
1
0
–
46
87.0
10.9
2.1
0
–
100
N
WFR/FIR
%
24
17
5
0
0
52.2
37.0
10.9
0
0
46
100
N
36
3
4
3
–
46
KPS
%
78.3
6.5
8.7
6.5
–
100
N
%
27
8
9
2
–
46
58.7
17.4
19.6
4.3
–
100
Average number of points in the scale ± standard deviation
(Średnia liczba punktów w skali ± odchylenie standardowe)
43.7 ± 3.5
Spearman’s rank correlation test
(Współczynnik korelacji rang Spearmana)
4.4 ± 0.7
90.4 ± 20.9
76.7 ± 15.5
rs = –0.49,
p < 0.001
rs = 0.78,
p < 0.001
rs = 0.56,
p < 0.001
*
FCS value excluded from the calculation due to a lack of cases.
GOS value excluded from the calculation due to a lack of cases.
**
*
Wartość dla SWF pominięta w obliczeniach ze względu na brak przypadków.
Wartość dla GOS pominięta w obliczeniach ze względu na brak przypadków.
**
Markiewicz et al. [15], patients with diagnosed
brain stem tumor showed neurological state disor−
ders in the form of paresis, balance and vision dis−
orders (deficiency in movement), swallowing dis−
orders (nutrition deficiency), and speech disorders.
According to the authors, operative treatment of
this condition (brain stem tumor) is connected
with risks and complications that impair the quali−
ty of life of patients.
Surveys by other authors [7] verifying the
application of quantitative methods for the assess−
ment of a patient’s state confirm a high correlation
of clinical scales (KPS, WHO) and care in neuro−
oncology (Self−care Capacity Scale).
The author conclude that a significant majori−
ty of the surveyed patients showed self−sufficiency
in the field of functional capacity on the day of dis−
charge. Functionality deficiency involved only
such fields as satisfying one’s own physiological
needs, maintaining own body hygiene, and feeling
intensive pain. The scales applied for the assess−
ment of the patients’ state (FCS, GOS, FIR, KPS)
correlated significantly, which recommends the
application of these scales in clinical assessment
and in planning nursing care at the neurosurgery
department.
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Functional Capacity After Brain Neoplasm Surgery
667
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Address for correspondence:
Robert Ślusarz
Neurological and Neurosurgical Nursing Department CM NCU
Techników 3
85−801 Bydgoszcz
Poland
Tel.: +48 052 585 21 93
Mobile: 668 121 095
E−mail: [email protected], [email protected]
Conflict of interest: None declared
Received: 28.05.2007
Revised: 12.06.2007
Accepted: 18.10.2007