Safety of Symptom-Based Modification of Physical Therapy Interventions in Pediatric Oncology Patients With and Without Low Blood Counts

Abstract

Background: Pediatric patients being treated for cancer often have low blood counts, yet physical therapy (PT) intervention and activity during treatment are thought to be important. The current practice at one institution is to modify PT interventions based on symptoms rather than relying on complete blood cell (CBC) counts. Purpose: This study investigates the safety of a symptomatic, rather than count-based, approach to modification of PT interventions in a pediatric cancer population at least 2 months into treatment. Methods: A retrospective chart review was performed to investigate the number and type of adverse events that occurred within 48 hours of a PT session in pediatric oncology patients. Information related to CBC values and type of interventions was abstracted from medical records. Associations between adverse events and low hemoglobin, platelets, and white blood cell (WBC) counts were assessed, and risk ratios were calculated. Results: CBC values were often abnormal. Adverse events occurred during or after 37 of 406 PT sessions, with the most common event being tachycardia not requiring medical intervention. No serious adverse events occurred. While an increased number of events occurred in those with low hemoglobin levels, this was nonsignificant when tachycardia was removed. A higher rate of adverse events did occur when platelets were below 20 000/mm3 (χ2 = 11.08, P = .001; Risk Ratio = 4.91; 95% confidence interval, 1.76-13.67), although none were bleeding-related. Low WBC count was not associated with an increased risk of adverse events. Conclusion: PT interventions can be safely incorporated into patient care when symptoms, rather than CBC values, guide clinical decision making about treatment modification.