Role of physiotherapy in the rehabilitation of palliative care patients

1. Role of physiotherapy in the rehabilitation of palliative care patients Caroline Belchamber Senior Oncology Physiotherapist Catherine Everett Senior Macmillan Physiotherapist August 2006

2. Aims • To be aware of the concept of rehabilitation in palliative care and the NICE guidelines on supportive and palliative care • To understand the role of palliative care physiotherapists • To be aware of the physiotherapy service for palliative care patients at Poole Hospital

3. NICE Guidelines • The rehabilitation needs for patients should be assessed at key points in the patient pathway • Cancer rehabilitation attempts to maximise patients ability to function, to promote their independence and to help them to adapt to their condition

4. Rehabilitation ‘To minimise some of the effects which the disease, or it’s treatment has on them. It is often possible to improve the quality of life regardless of their prognosis by helping them to achieve their maximum potential of functional ability and independence or gain relief from distressing symptoms’ ACPOPC 1993

5. The role of the physiotherapist in palliative care • Physiotherapists work with respiratory, neurological, lymphatic, orthopaedic, musculoskeletal, pain and haemotalogical conditions • Education and training of MDT as well as patients and carers • Dissemination of information to MDT with key role in discharge planning • Communication and collaboration between primary and secondary care

6. Physiotherapy interventions • Positioning – prevention of pressure sores • TENS – pain and nausea control • Respiratory care – Non-pharmacological approach and prevention of retained secretions and oxygen therapy • Neurological rehabilitation – e.g SCC, Brain tumours and peripheral neuropathies • Mobility – Exercise tolerance, maintenance and independence • Passive/active range of movement – prevention of contractures • Individual exercise programmes

7. Poole hospital physiotherapy palliative care service • In-patient palliative care service • Two wards with 41 beds • On average 30 patients requiring physio a week • 0.6 FTE Oncology physiotherapist since May 2003 • FTE Macmillan physiotherapist since June 2005 • Expanding palliative care physiotherapy service • Rehabilitation slots introduced in August 2005

8. Case Study • 61 year old male SCC • Presented with decreased mobility with pain in right shoulder • PMH – Ca prostate • MRI – 24th Feb cord compression at T2 with extensive disease to T1, T2 and L3 • Physiotherapy assessment • Physiotherapy management

9. Conclusion • AHP and their role needs to be recognised in this specialist area of rehabilitation • AHP give ‘control’ back to palliative care patients • AHP increase palliative care patients QOL • Rehabilitation commences from time of diagnosis through the whole cancer trajectory

10. ‘With in the context of palliative care, realistic joint goal setting gives the patient a measure of control, often at a time when they are experiencing helplessness and loss of independence’ Robinson 2000

11. References • NICE guidelines: Supportive and palliative care: Chapter 10: DOH 2004 • Jollife, J and Bury (2000). The effectiveness of physiotherapy in palliative care of older people, CSP. • Role of physiotherapy in palliative care ACPOPC 2003