Parsons Janet A, Davis Aileen M
Toronto Rehabilitation Institute, Canada.
Curr Treat Options Oncol. 2004 Dec;5(6):477-88. doi: 10.1007/s11864-004-0036-0.
The current standard of care for soft tissue sarcoma (STS) is limb salvage surgery and adjuvant radiotherapy, with long-term survival rates of approximately 70%. However, the extensive surgical resection and subsequent reconstruction result in 50% of survivors living with chronic disability. Rehabilitation aims to optimize functional independence and quality of life, and is routinely offered to patients undergoing surgical treatment for STS. Unfortunately, there is a dearth of research related to rehabilitation in this area. We propose a model for assessing disability, for designing treatment interventions and for evaluating rehabilitative outcomes in STS. The World Health Organization's (WHO) international classification of functioning, disability, and health (ICF) is divided into three domains: 1) impairments (related to body structure and function), 2) activity limitations (related to usual self-care activities/activities of daily living), and 3) participation restrictions (related to social roles). A literature review of STS rehabilitation reveals that most studies have focused on disability assessment, with few papers describing or evaluating rehabilitation interventions commonly employed in STS. Clinicians are forced to extrapolate findings from other patient populations in order to evaluate the effectiveness of specific rehabilitation strategies (ie, those used for particular sequelae of STS, such as lymphedema or impaired exercise tolerance). There is strongest support for complex decongestive physiotherapy (targeting lymphedema) and aerobic exercise interventions (aimed at alleviating cancer-related fatigue and psychosocial sequelae). The most poorly researched topic is rehabilitation for genitourinary disability (both incontinence and sexual dysfunction). Most studies related to oncologic rehabilitation are restricted to the impairment level (eg, affecting range of motion, muscle strength) of the ICF, with only a small minority addressing activity limitations (eg, affecting activities of daily living) experienced by patients. A consideration of participation restrictions (eg, fulfillment of vocational roles) is almost wholly absent from the literature. Yet social role reintegration is of fundamental importance to patients. Further research is required in these two domains. The ICF provides a comprehensive framework for future research into rehabilitation interventions for STS.
软组织肉瘤（STS）目前的标准治疗方法是保肢手术和辅助放疗，长期生存率约为70%。然而，广泛的手术切除及随后的重建导致50%的幸存者患有慢性残疾。康复的目的是优化功能独立性和生活质量，并且通常会为接受STS手术治疗的患者提供康复服务。不幸的是，该领域中与康复相关的研究匮乏。我们提出了一个用于评估残疾、设计治疗干预措施以及评估STS康复效果的模型。世界卫生组织（WHO）的国际功能、残疾和健康分类（ICF）分为三个领域：1）损伤（与身体结构和功能相关），2）活动受限（与日常自我护理活动/日常生活活动相关），3）参与限制（与社会角色相关）。对STS康复的文献综述表明，大多数研究都集中在残疾评估上，很少有论文描述或评估STS中常用的康复干预措施。临床医生不得不从其他患者群体中推断研究结果，以评估特定康复策略（即用于STS特定后遗症的策略，如淋巴水肿或运动耐量受损）的有效性。对于复杂的消肿物理治疗（针对淋巴水肿）和有氧运动干预（旨在减轻癌症相关疲劳和心理社会后遗症）有最强的支持。研究最少的主题是泌尿生殖系统残疾（包括尿失禁和性功能障碍）的康复。大多数与肿瘤康复相关的研究仅限于ICF的损伤水平（例如，影响活动范围、肌肉力量），只有少数研究涉及患者经历的活动受限（例如，影响日常生活活动）。文献中几乎完全没有考虑参与限制（例如，职业角色的履行）。然而，社会角色重新融入对患者至关重要。这两个领域都需要进一步的研究。ICF为未来STS康复干预研究提供了一个全面的框架。
