By Dr. Inshall Nadeem, Dr. Alina Atif Khan
Abstract:
Introduction:
This study aimed to evaluate the impact of a structured
neuro-oncological rehabilitation program on functional
independence and performance status among glioma patients
receiving radiotherapy ± chemotherapy. The primary focus was
to assess the change in Eastern Cooperative Oncology Group
(ECOG) performance scores, Functional Independence
Measure (FIM), and Berg Balance Scale (BBS) outcomes
between patients who received comprehensive rehabilitation
with standard care and those managed with standard care only.
Methods:
This is a retrospective cohort study conducted at Cyberknife
and TomoTherapy Unit, Jinnah Postgraduate Medical Centre
(JPMC), Karachi, from September 2022 to September 2025. A
total of 127 patients with histopathologically and radiologically
confirmed gliomas were included and divided into an
experimental group (n = 63) receiving neuro-oncological
rehabilitation along with standard oncological care and a
control group (n = 64) receiving standard oncological care
only. The multidisciplinary rehabilitation program comprised
individualized physical therapy, occupational therapy,
psycho-oncological, and neuropsychological support tailored
to each patient’s needs. Functional outcomes were evaluated
using ECOG, FIM, and BBS scores at admission and discharge.
Statistical analyses included the Wilcoxon Signed-Rank Test
for within-group comparisons and the Mann–Whitney U test
for between-group differences, with a significance level of p <
0.05.
Results:
Males predominated in both groups (experimental: 71.4%;
control: 62.5%). The most frequent diagnosis was glioma (experimental: 60.9%; control: 45.3%), and nearly half of all
participants presented with WHO Grade 4 tumours, confirming
baseline comparability. At admission, most patients in the
experimental group had ECOG scores of 2–3, indicating
moderate to severe limitation. Following rehabilitation, 74.6%
achieved ECOG 0 and 25.4% ECOG 1, demonstrating
substantial functional recovery (Z = −6.775, p < 0.001). The
control group showed modest improvement (Z = −2.642, p =
0.008), with the majority remaining at ECOG 1–2.
Between-group comparison revealed a significant difference in
ECOG change (p < 0.001), favouring the rehabilitation group.
Functional Independence Measure (FIM) scores increased
significantly in the experimental group (mean 88.95 → 96.08,
Z = −6.782, p < 0.001) versus minimal change in controls (p =
0.214). Similarly, Berg Balance Scale (BBS) scores improved
markedly (mean 41.84 → 44.92, Z = −6.593, p < 0.001)
compared with negligible gains in the control group (p =
0.153). These findings confirm notable improvements in
functional independence and balance outcomes following
neuro-oncological rehabilitation.
Conclusion:
Neuro-oncological rehabilitation is an effective adjunct to
oncological treatment, significantly improving functional
independence, balance, and performance status among glioma
patients undergoing radiotherapy ± chemotherapy. These
findings underscore the importance of integrating structured
rehabilitation programs into neuro-oncology care pathways to
optimize recovery and quality of life.