Špela Matko

Background/Objectives: Cancer survivors admitted to inpatient rehabilitation suffer from a complex burden of interrelated physical and psychological symptoms. While mean-level improvements during rehabilitation are well-documented, it remains unknown whether rehabilitation modifies the underlying structure of symptom interconnections—the symptom network—beyond reducing individual symptom scores. This study aimed to characterize symptom network structure at admission and discharge of a 21-day inpatient cancer rehabilitation program based on cancer-related physical symptoms and psychosocial functioning, formally compare network topology across timepoints, identify structurally central treatment targets, and assess the transdiagnostic generalizability of findings. Methods: Secondary analysis of routinely collected, electronic patient-reported outcome (PRO) data from 5066 cancer survivors (mean age 60.3 years, SD 12.2; 64.2% female; most frequent diagnoses: breast cancer = 36.9%, hematological malignancies = 10.4%; prostate cancer = 8.5%) admitted to a single-center inpatient rehabilitation program was performed between January 2017 and November 2022. The EORTC QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS) questionnaires were utilized. Bayesian Gaussian Graphical Models were estimated at admission (T0) and discharge (T1) across 17 symptom and functioning domains using Bayesian Model Averaging (15,000 iterations). Edge-level change was quantified via posterior distributions of pairwise differences with 95% Highest Density Intervals. Node-level changes were assessed using Bayesian paired t-tests. Centrality was quantified by Expected Influence and Bridge Expected Influence. Results: Patients showed clinically meaningful improvements across all 17 domains during rehabilitation (all Bayes Factors >10; posterior probability of direction >99.9%). The largest standardized effects were observed for emotional functioning (Cohen’s d = 0.76), global health status (d = 0.69), and fatigue (d = 0.53). These improvements were clinically meaningful for a substantial proportion of patients: 62% improved by at least the minimal important difference in fatigue and 58% in emotional functioning, and the proportion of patients with probable anxiety fell from 15% to 6% and probable depression from 10% to 4%. Emotional functioning and anxiety were the most central domains in the symptom network—most strongly connected to the rest of patients’ symptom burden—at both admission and discharge. Despite the clinical improvements, the overall architecture of symptom interconnections changed little (83% of connections were unchanged). This indicates that the severity of symptoms was mitigated while the structure linking them together remained largely intact. The one connection that strengthened was that between impaired social functioning and financial difficulties (Δ = −0.112). Structural findings were consistent across ten cancer types (leave-one-out r > 0.80 in seven of ten). Conclusions: Over the course of inpatient cancer rehabilitation, patients showed large improvements against a background of largely stable symptom network architecture. Emotional functioning and anxiety occupy structurally central positions at both admission and discharge, identifying them as candidate domains warranting further investigation for network-informed rehabilitation. These findings provide a novel structural perspective on oncological rehabilitation and a framework for developing more targeted intervention strategies.

The success of rehabilitation is usually assessed based on the results reported by patients and physicians. However, these assessments often vary and frequently fail to take psychosocial and contextual factors into account. This study investigated how patient researchers (PRs) and health researchers (HPRs) perceive rehabilitation outcomes and which critical success factors (CSFs) they consider most influential. Using a participatory mixed-methods design, 90 anonymized patient records were evaluated and divided into groups based on good, poor, and conflicting outcomes. The participants—23 PRs and 24 HPRs—assessed the success of rehabilitation and the potential significance of previously identified CSFs. In contrast to the HPRs, the PRs attributed greater influence to psychosocial factors. The HPRs generally provided a more accurate assessment of the outcome ratings in the patient records, correctly classifying 54.5% vs. 47.7%. Ultimately, the most important CSFs were incorporated into the Rehabilitation Expectation and Perception Scale (REPS), a screening instrument for identifying context-sensitive factors that influence rehabilitation success. This new approach supports personalized, context-sensitive rehabilitation planning, aiming to optimize treatment and facilitate a more nuanced assessment of rehabilitation success.

Background: Assessment of gait function is crucial for optimising rehabilitation outcomes. The gait analysis and motion score (GAMS) summarises qualitative and quantitative gait parameters from treadmill-based analyses to evaluate functional walking status. Objectives: To assess the sensitivity of the GAMS for detecting short-term changes, its test–retest reliability, and its correlation with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and Go (TUG) test. Methods: A retrospective analysis of 94 inpatient rehabilitation patients with hip, knee, or ankle impairments was performed. Changes in GAMS, WOMAC, and TUG scores and their interrelationships were assessed at both admission and discharge. Results: GAMS, WOMAC, and TUG showed significant improvements over time, with medium effect sizes (η² = 0.303 to 0.434; p < 0.001). No significant differences in outcome measures were observed between groups. Moderate to strong correlations were found between pre- and post-rehabilitation scores for GAMS, TUG, and WOMAC (r = 0.58 to r = 0.90), indicating good test–retest reliability. A significant low negative correlation between GAMS and TUG was observed for all patients at admission (r = −0.30, p = 0.003) and discharge (r = −0.26, p = 0.030). No significant correlations were observed between GAMS and WOMAC in any patient group. Baseline GAMS scores significantly influenced change scores. Conclusions: GAMS is a sensitive and reliable tool for detecting short-term changes in gait parameters. GAMS and TUG assess related but distinct constructs, with GAMS and WOMAC assessing different domains of gait function. Therefore, GAMS provides complementary information not captured by WOMAC or TUG.

Many patients with head-and-neck cancer (HNC) suffer from speech or swallowing disorders. We investigated the impact of dysphagia on health-related quality of life (HRQOL), functioning, and distress in HNC survivors, and whether cancer rehabilitation can alleviate these conditions. Before admission (T0) and at discharge (T1) of three-week inpatient cancer rehabilitation, patient-reported outcomes were collected. HRQOL, symptoms, functioning, and psychological distress were assessed with EORTC QLQ-C30 and Hospital Anxiety and Depression Scale (HADS) questionnaires. Of 63 HNC patients, 22 had dysphagia, 23 needed no speech therapy (Control-1), and 18 needed speech therapy, but showed no symptoms of dysphagia (Control-2). Before rehabilitation, HRQOL, physical, social, and emotional functioning were significantly lower in dysphagia patients than in controls. Dysphagia patients reported more severe general symptoms including fatigue, pain, sleep disturbances, nausea/vomiting, diarrhea, and financial worries. Furthermore, the emotional and social functioning of Control-2 was significantly worse than Control-1. For all HNC patients, social, emotional, and role functioning, fatigue, nausea/vomiting, insomnia, and appetite loss significantly improved at T1. Improvements in HRQOL were most noticeable in dysphagia patients. Psychooncological counseling reduced depression in dysphagia and Control-2 patients to levels seen in the general population. In conclusion, dysphagia patients suffer severely from impaired functioning and systemic symptoms but benefit substantially from rehabilitation.

Background/Objectives: Patient-reported outcome measures (PROMs) and clinician-reported outcome measures (CROMs) are used in orthopaedic rehabilitation to evaluate patients’ health status and recovery. However, controversy still exists regarding their relevance and validity. This evaluation was conducted to assess the effectiveness and role of PROMs and CROMs in the orthopaedic rehabilitation outcome of patients who have undergone either total knee arthroplasty or hip arthroplasty. Methods: Outcome measures of 409 patients (68.3 ± 9.3 years; 34.2% male) with total knee arthroplasty and 308 patients (68.1 ± 10.6 years; 36.3% male) with total hip arthroplasty (control group) were assessed at baseline and after 21 days of inpatient rehabilitation. Effect sizes and correlations were analysed as they related to the use of PROMs and CROMs. To reduce statistical distortions caused by ceiling effects, we used a performance score (T2D) relying on two scores taken at the beginning and end of rehabilitation. Results: Large effect sizes (d > 0.97) for CROMs and medium effect sizes (d ≥ 0.65) for PROMs were observed in both groups. The standardised mean difference across all outcomes was 0.83 ± 0.59. PROMs worsened in 13.1% of all patients, while almost no patients showed a deterioration in CROMs. Correlations were highest between the Timed Up and Go and the Health Assessment Questionnaire scores (ρ > 0.45). Conclusions: Different and complementary assessment modalities of PROMs and CROMs serve as valuable clinical tools, providing a valid basis for interpreting patients’ health outcomes.

The study compares the body mass index (BMI), 10-m walk test results, and self-rated health-related quality of life (HRQoL) of patients awaiting total knee or hip arthroplasty with age and sex-matched controls. Additionally, we investigated relationships between these variables to better understand how mobility impairments and HRQoL contribute to the need for surgical intervention. Forty-three patients (age: 66.7 ± 8.7 years) awaiting total knee arthroplasty (n = 23) or total hip arthroplasty (n = 20) and 54 healthy control individuals (age: 65.6 ± 1.5 years) participated in this study. Weight and height were measured, the BMI was calculated, the 10 m walk test was performed, and HRQoL was assessed using the EQ-5D-5L questionnaire. Patients had a significantly higher BMI than controls (p = 0.037), with the majority of both groups classified as overweight or obese (patients, 86%; controls, 73%). Patients also walked significantly more slowly than controls (p < 0.001). HRQoL was significantly lower in patients across all dimensions (p < 0.001), with the greatest impairments observed in mobility, usual activities, and pain. Significant but weak correlations (p = 0.001–0.042, r_s = 0.31–0.48) were found between the HRQoL, BMI, and 10 m walk test results. These findings confirm that patients awaiting total knee or hip arthroplasty exhibit an increased BMI, reduced locomotor function, and impaired HRQoL, highlighting the extent of functional limitations in individuals with end-stage osteoarthritis. The strong association between mobility impairments and HRQoL further underscores the impact of osteoarthritis on daily life and the increasing need for surgical intervention.

Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness—the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation—is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55–82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen’s d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.