Neurorehabilitation zerebraler Gliome: Implikationen für die soziale und berufliche Integration

Zusammenfassung

Die glialen Tumoren gehören zu den häufigsten primären Tumoren des zentralen Nervensystems und weisen ein variables biologisches und klinisches Verhalten abhängig vom Malignitätsgrad (WHO-Grad) auf. Im Rahmen einer retrospektiven Studie wurden 350 Patienten mit der Diagnose zerebrale Gliome im Alter zwischen 22 und 84 Jahren rekrutiert, die in der Klinik für Neurologie des Reha-Zentrums Bad Orb stationär behandelt wurden. In die Studie eingeschlossen wurden alle Patienten mit histologisch gesicherten zerebralen Gliomen und vorliegender Graduierung der Malignität nach der WHO-Klassifikation (n=333). Unsere retrospektive Analyse legte nahe, dass der höhere Malignitätsgrad (WHO-Grad III und IV bei 86% der Patienten mit Leistungseinschränkungen), das Alter (56,4±3,46; p≤0,005 vs. 48,3±1,53; p≤0,005) sowie kognitive Defizite (71% der Patienten mit Leistungseinschränkungen) prognostisch als entscheidende limitierende Faktoren für die erfolgreiche berufliche Integration sowie die Aufrechterhaltung von Alltagskompetenzen zu identifizieren sind. Diese Arbeit trägt zu einem besseren Verständnis der Komplexität neuroonkologischer und sozialmedizinischer Versorgung im Rahmen der stationären Neurorehabilitation bei. Die Analyse und unsere Erfahrung zeigen, dass die zeitnahe Beurteilung der umweltbezogenen Kontextfaktoren, der psychosozialen Krankheitsfolgen sowie der Leistungsfähigkeit und Alltagskompetenzen enorm wichtig für die langfristige, erfolgreiche neuroonkologische Betreuung ist.

Abstract

Gliomas are among the most frequent primary brain tumors. Treatment expenses, early retirement and need of long-term care result in rising public healthcare expenditures. This retrospective study includes 333 patients with a histological confirmed diagnosis of cerebral gliomas according to the WHO-classification, who underwent a rehabilitation therapy in the Neurology Department of Clinic Bad Orb, Bad Orb, Germany. Higher age (56,4±3,46; p≤0,005 vs. 48,3±1,53; p≤0,005), glioma malignancy (WHO III and IV in 86% of disabled patients) and cognitive limitations (71% of disabled patients) were identified as risk factors for limitations with respect to activities of everyday life and occupational reintegration. Not only do standardised concepts of care improve the quality of patient-centred care, but they also help to minimize consequential costs. Their implementation requires profound knowledge of therapeutic strategies and sociomedical regulations. Medical treatment and sociomedical care have to be regularly reevaluated and adapted to the patient’s needs and disease severity. An optimal concept of therapy ensures the patients’ long-term social integration and improves compliance and occupational integration.

Schlüsselwörter

Zerebrale Gliome - Integration - Neurorehabilitation

Key words

gliomas - integration - neurorehabilitation

Publication History

Article published online:
09 September 2022

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