Medical Journal of the Islamic Republic Of Iran

en Multidisciplinary Rehabilitation vs. Standard Care in Pediatric CNS Tumor Survivors: A National Cohort Study from Kazakhstan Rehabilitation Rehabilitation Original Research Original Research     Background: Childhood survivors of CNS tumors are at high risk for long-term neurological, cognitive, and functional impairments. In Kazakhstan and many low- and middle-income countries (LMICs), standardized rehabilitation services and outcome tracking systems are largely lacking. To assess the effectiveness of Kazakhstan’s inaugural national multidisciplinary rehabilitation program for children with CNS tumors, utilizing data from a newly established pediatric oncology registry.    Methods: This retrospective cohort study with prospective follow-up included 600 children aged 3–17 years with CNS tumors. The intervention group (n=300) received structured rehabilitation, which encompassed physiotherapy, physical education, speech therapy, neuropsychological therapy, psychological support, hippotherapy, sensory integration, and occupational therapy. The control group (n=300) received standard post-treatment follow-up without rehabilitation. Outcomes were assessed using the Pediatric Evaluation of Disability Inventory (PEDI), Pediatric Quality of Life Inventory (PedsQL), the OncoLife caregiver questionnaire, and neuropsychological testing. During the study period, standard care in Kazakhstan included routine oncological follow-up visits, symptom-driven neurological consultations, and general medical management. However, structured multidisciplinary rehabilitation services were not systematically available.    Results: All children in the intervention group completed the rehabilitation program without experiencing serious adverse events. Compared to the control group, the rehabilitation group demonstrated significantly greater improvements in functional independence (+14.23 PEDI points), quality of life (+20.04 PedsQL points), caregiver-reported outcomes (+15.23 OncoLife points), and cognitive performance (+17.75 neuropsychological points) (all P<0.001). Clinical gains included restored ambulation, enhanced communication, and improved school participation. Based on these results, a national rehabilitation protocol was endorsed by the Ministry of Health and integrated into pediatric oncology care.    Conclusion: The national implementation of multidisciplinary rehabilitation for pediatric CNS tumor survivors in Kazakhstan has significantly improved health and functional outcomes without raising safety concerns. These findings advocate for the integration of rehabilitation into pediatric oncology care in low- and middle-income countries (LMICs).   Pediatric oncology, Central nervous system tumors, Multidisciplinary rehabilitation, Pediatric cancer survivorship, Health system strengthening, National patient registries, Implementation science, Kazakhstan, Low- and middle-income countries (LMICs) 365 380 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-8547-5&slc_lang=en&sid=1 Nurzhan Bikhanov zarkin48@gmail.com 200319475328460097632 200319475328460097632 No The Clinical Academic Department of Surgery, University Medical Center Corporate Fund (UMC), Astana city, Mangilik El str.11-6, 010017, Republic of Kazakhstan Aigul Kaliyeva aigulkalieva07@gmail.com 200319475328460097633 200319475328460097633 No University Medical Center Corporate Fund (UMC), Astana City, Kerey Zhanibek Hana str.3/2, 010000, Republic of Kazakhstan Galiya K. Sermanizova sermanizovagk@mail.ru 200319475328460097634 0009-0008-9330-3225 No Medical Center Sholpan Ospanova ospanova.sh@amu.kz 200319475328460097635 0009-0003-3500-3906 No Department of Public Health and Management, Astana Medical University», Astana city, Saryarka str. 33-719, 010000, Republic of Kazakhstan Ulugbek Musaev musaev_ulugbek84@mail.ru 200319475328460097636 0009-0002-2021-2185 No Department of Public Health, Healthcare Management and Physical Education, Tashkent State Medical University, Tashkent city, Faraby str. 2, 100109, Republic of Uzbekistan Gaukhar Dauletova dauletova.g@amu.kz 200319475328460097637 200319475328460097637 No Department of Public Health and Management, Astana Medical University», Astana city, Saryarka str. 33-719, 010000, Republic of Kazakhstan Assiya K. Turgambayeva turgambaeva.a@amu.kz 200319475328460097638 200319475328460097638 Yes Department of Public Health and Management, Astana Medical University», Astana city, Saryarka str. 33-719, 010000, Republic of Kazakhstan Aliya Turgambayeva turalia759@gmail.com 200319475328460097639 200319475328460097639 No Accouting Depertment, National Bank of Kazakhstan, Astana city, Mangilik El 64, 010000, Republic of Kazakhstan