Rehabilitation Principles in Bone Metastasis

Abstract

Metastatic bone disease is often associated with a decline in function and overall quality of life. Pain and musculoskeletal events are contributors to decrease mobility and independence.4, 5, 6, 7 In cases where there is neurological involvement, such as in patients with cord compression syndrome, it can be associated with neurogenic bowel and bladder. The role of cancer rehabilitation providers is to improve the overall health-related quality of life and their function and independence. Rehabilitation interventions, including aerobic and resistant exercise prescription, are associated with positive physical and self-reported outcomes with a low rate of adverse events.4 Low impact aerobic activity has been wildly studied in patients with bone metastasis and has been found to be safe.4,9 Rehabilitation physicians focus on designing a rehabilitation and exercise plan that improves the patient's physical function while keeping in mind the necessary precautions to prevent musculoskeletal events. Activity modification and physical activity that prevents the axial loading of the spine can improve the core musculature of patients with spine involvement while decreasing the risk of compression fractures of the vertebral bodies.21 Furthermore, patients who have undergone surgical interventions as part of the treatment of metastatic bone disease frequently present an acute functional decline. Rehabilitation providers are vital in evaluating these functional impairments and developing a comprehensive rehabilitation plan in the appropriate setting (inpatient vs home vs outpatient).26 Overall, patients with metastatic bone disease present with functional impairments that put them at risk for immobility-related complications. Rehabilitation interventions, such as exercise, are safe and effective in improving immobility complications, decreasing caregiver burden, and improving overall quality of life.4,7,9,26