Abstract
Introduction: Gynecological cancer survivors completing chemotherapy has a diverse presentation of pain, neurological disturbances and functional impairments that constitutes several impairments in ICF framework that hinders optimum quality of life. The study intended to determine the impact of Physiotherapy interventions through clinical reasoning procedure by international classification of functioning, disability and health (ICF). Case Report: The case was a uterine carcinoma case completing surgery and chemotherapy and seeks Physiotherapy complaining lower back pain, numbness and decreased strength in both lower limbs with functional and psycho-social impairments. The patient has been managed in three tract reasoning and Hypothetco deductive reasoning process of clinical reasoning. The Interventions focused on strengthening exercise of lower limbs, pelvic floor exercise, aerobic exercise and exercise to improve balance. After two weeks, Mckenzie extension approach for lumbar spine and neural sliding of lower limbs has been added as adjacent therapy. Treatment has been provided for eight sessions in four weeks and continued home exercises for another four weeks. Outcome has been measured and found positive effects on in pain redaction, remission of numbness, improvement of balance, strength of lower limb and quality of life measure.Single session follow up after three months from screening revealed sustainability of improvements that reflects efficacy of physiotherapy interventions in diverse indicator in ICF framework. Conclusion: Chemotherapy induced musculoskeletal complications are certainly manageable through physiotherapy interventions and McKenzie extension approach found effective to remission of lumber radicular symptoms in CIPN. The interventions have positive effect in longer run and upon quality of life in gynecological cancer survivors.
Highlights
INTRODUCTIONUterine cancer is one of the leading cancers of female population worldwide. United States has forty thousand diagnoses each year [1] and in Bangladesh cervical cancer has prevalence of 26.1% second in leading cancers in women [2]
Gynecological cancer survivors completing chemotherapy has a diverse presentation of pain, neurological disturbances and functional impairments that constitutes several impairments in ICF framework that hinders optimum quality of life
Chemotherapy induced musculoskeletal complications are certainly manageable through physiotherapy interventions and McKenzie extension approach found effective to remission of lumber radicular symptoms in Chemotherapy Induced Peripheral Neuropathy (CIPN)
Summary
Uterine cancer is one of the leading cancers of female population worldwide. United States has forty thousand diagnoses each year [1] and in Bangladesh cervical cancer has prevalence of 26.1% second in leading cancers in women [2]. Brown states [4] cervical cancer has associated long term impairment in physical function alongside disturbance in daily leaving activities including walking and working in standing position. The CIPN case presented in the study correlates the stated impairments and has been managed in accordance with standard protocol of care by Physiotherapy in Gynecology & Women’s Health subspecialty. The management protocol included patient education, stretching exercise, strengthening exercise, stabilization exercise, Balance exercise & Aerobic exercise as described in appendix 1, table 1, twice a week for 4 weeks in physiotherapy session and practiced every day at home for one month. Based on cues the possible differential diagnosis determined, it could be associated with the pathological change in nerves due to chemotherapy or could be mechanical low back pain or a case of complex regional pain syndrome (CRPS). Patient had full assurance of confidentiality and informed that she could leave the study anytime she wishes
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