Rehabilitation utilization in malignant primary brain tumors compared to stroke and traumatic brain injury: Analysis using a large claim database

Samantha Giovanazzi; Beatrice Ugiliweneza; Elsa Alvarez; Maxwell Boakye; Darryl Kaelin; Megan B Nelson

doi:10.1093/nop/npae064

Rehabilitation utilization in malignant primary brain tumors compared to stroke and traumatic brain injury: Analysis using a large claim database

Neurooncol Pract. 2024 Jul 16;11(6):803-812. doi: 10.1093/nop/npae064. eCollection 2024 Dec.

Authors

Samantha Giovanazzi¹, Beatrice Ugiliweneza^{2

3}, Elsa Alvarez^{2

3}, Maxwell Boakye³, Darryl Kaelin^{3

4}, Megan B Nelson^{3

4}

Affiliations

¹ Rehabilitation Services, Norton Healthcare, Louisville, Kentucky, USA.
² Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.
³ Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
⁴ Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky, USA.

PMID: 39554790
PMCID: PMC11567749 (available on 2025-07-16)
DOI: 10.1093/nop/npae064

Abstract

Background: There is concern regarding the underutilization of rehabilitation services for the malignant primary brain tumor (MPBT) population following hospitalization. Our aim is to assess physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) use after an MPBT diagnosis, evaluate the trend from 2001 to 2018, and compare to traumatic brain injury (TBI) and stroke.

Methods: Adult cases of MPBT, TBI, and stroke were extracted from MarketScan database. Inpatient and outpatient data were screened for inpatient rehabilitation use at the time of diagnosis and postdischarge outpatient PT, OT, and SLP over 12 months. Generalized linear regressions were used for analysis.

Results: The cohort was composed of 3381 MPBT, 205 366 stroke, and 24 825 TBI patients. After diagnosis, 1% of MPBTs were discharged to skilled nursing facilities (SNF) and 3% to inpatient rehabilitation facilities (IRF). Rehabilitation use at 12 months was 19% PT, 8% OT, and 6% SLP. These percentages were lower than stroke and TBI; stroke: 8% SNF, 8% IRF, 22% PT, 10% OT, and 8% SLP; TBI: 7% SNF, 7% IRF, 22% PT, 8% OT, and 6% SLP. Outpatient therapies increased from 2001 to 2018, with PT use consistently higher than OT and SLP. MPBT had the greatest increases in OT (7.95 times) and PT (3.89 times) compared to stroke and TBI, while stroke had the greatest increase in SLP (0.98 times).

Conclusions: MPBT patients had the highest increase in OT and PT utilization when compared to stroke and TBI. However, there remains a utilization gap which demonstrates the need for improvement.

Keywords: brain tumor; rehabilitation; utilization.

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