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

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 a MPBT diagnosis, evaluate the trend from 2001-2018, and compare to traumatic brain injury (TBI) and stroke. 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 post-discharge outpatient PT, OT, and SLP over 12 months. Generalized linear regressions were used for analysis. Cohort was composed of 3,381 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 (.98 times). MPBT patients had the highest increase of OT and PT utilization when compared to stroke and TBI. However, there remains a utilization gap which demonstrates the need for improvement.