Systematic Review of Functional Outcomes in Cancer Rehabilitation.

OBJECTIVE: To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION: Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION: Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS: Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS: These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Shoulder-Specific Patient-Reported Outcome Measures for Use in Patients With Head and Neck Cancer: An Assessment of Reliability, Construct Validity, and Overall Appropriateness of Test Score Interpretation Using Rasch Analysis.

OBJECTIVES: The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis. METHODS: One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII). RESULTS: DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics. CONCLUSIONS: Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended. IMPACT: This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians.

Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review.

BACKGROUND: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE: This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES: PubMed and CINAHL were searched up to September 2018. STUDY SELECTION: Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION: Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS: Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS: Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS: This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.

Reliability and a correlational analysis of the 6MWT, ten-meter walk test, thirty second sit to stand, and the linear analog scale of function in patients with head and neck cancer.

OBJECTIVE: The purpose of this study was to establish the test-retest reliability of and relationships between various measures of physical function in a cohort of individuals in the early treatment stages for head and neck cancer (HNC). METHODS: The Six-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), 30-Second Sit to Stand (30STS), and Linear Analog Scale of Function (LASF) were administered to 42 participants with a diagnosis of HNC. Test-retest reliability and correlations between the measures are reported. RESULTS: The 6MWT, 10MWT, 30STS, and LASF demonstrate excellent test-retest reliability (ICC = 0.901-0.960). The 6MWT exhibits a moderate to good relationship with the 10MWT (r = 0.684, p < 0.001), whereas the relationship between the 30STS and the 6MWT (r = 0.407, p = 0.007) and 10MWT (r = 0.322, p = 0.038) is fair. The LASF does not correlate significantly with the 6MWT, 10MWT, or 30STS. CONCLUSIONS: The 6MWT, 10MWT, 30STS, and LASF are reliable measurement instruments for patients treated for HNC. The 6MWT, 10MWT, and 30STS are significantly correlated suggesting they may measure subconstructs of physical function. The LASF does not correlate significantly with the 6MWT, 10MWT and 30STS in this sample.