Physiotherapy In Palliative Care Research Articles

Ensuring quality of life in palliative care physiotherapy in developing countries.

Palliative care (PC) focuses on the body, mind, and spirit and can also provide pain and symptom relief, clarifying and focusing the provision of care on the patient's desires and goals, and helping them understand their disease and its treatment plans. Although PC is widely recognized for its applicability near the end of life or during terminal illness, it is also applicable and beneficial for patients with diseases in their earlier stages. Near the end of life, palliative care often focuses on providing continual symptom management and supportive care. Although palliative care has been noted to improve some life expectancy, its primary aim is to improve quality of life via focusing on the comfort of the patient, maintaining dignity, reducing intensive care utilization, and avoidance of expensive hospitalizations. One major challenge to quality of life for patients in PC is the physical and functional decline that occurs with disease progression. These issues can be addressed by specialized PC physiotherapy. Uniform provision of high-quality PC services (and physiotherapy in palliative care) faces substantial challenges in resource-challenged settings, including low- and middle-income countries. When properly integrated into PC teams and adequately supported, physiotherapy within PC can address common symptoms (pain, breathlessness, weakness) and assist patients to remain in an adapted home setting to optimize their quality of life, safety, and dignity.

Cultural Adaptation and Testing of the Italian Version of the Edmonton Functional Assessment Tool-2 (EFAT2-I).

Physiotherapy in Palliative Care (PC) is effective in the management of a series of respiratory, circulatory and motor symptoms, and often has a positive impact on the patient's mood. The Edmonton Functional Assessment Tool (EFAT) is the only existing validated tool specifically designed for functional assessment in PC, and its use has been recommended in clinical practice. To date, no Italian version of the tool has been validated. The aim of this study was to translate, cross-culturally adapt, and evaluate the psychometric properties of the Italian version of the EFAT2. After receiving formal permission from the author, Beaton guidelines for cross-cultural adaptation were followed, namely: (1) forward translation; (2) a multidisciplinary focus group (including 4 physiotherapists, 1 physician, 3 nurses, 1 occupational therapist, 1 psychologist) to assess semantic, idiomatic, experiential, and conceptual equivalence; (3) backward translation. The Content Validity Index (CVI) was used to assess content validity of the tool. Construct and concurrent validity were also evaluated. To evaluate the reliability of the EFAT2-I, reliability was measured using Cronbach alfa, item-total correlation, and Cohen's Kappa. 119 patients admitted to a Palliative Care Unit (Italy) agreed to participate in the study. The EFAT2-I mean score was 11.3, ranging from 0 to 30. Very good CVI scores were achieved, both in terms of single item validity (I-CVI) and of whole scale validity (S-CVI). Positive results were obtained from construct, concurrent validity assessment and measures of reliability. The EFAT2-I showed good psychometric properties and can be used as a rehabilitation assessment tool in palliative care settings. The validation of the Italian version will allow comparison of different centres and palliative care facilities on national and international levels.

Role of physiotherapy in palliative care

Introduction: Multiple cutaneous warts are often asymptomatic, cosmetically disfiguring and difficult to treat with conventional modalities, hence immunotherapeutic modalities can be used in such cases. There are no comparitive studies with immunotherapeutic modalities for the treatment of multiple and extensive warts. This study aims to compare the efficacy and safety of intralesional BCG and PPD in the treatment of multiple cutaneous warts. Materials and Methods: It is a double blinded randomized clinical trial involving thirty patients having more than ten cutaneous warts with a positive mantoux reaction. The patients were randomly allocated into two treatment groups, group A – PPD and group B - BCG. Intralesional injections were given at two weekly intervals till complete clearance of all the warts or for a maximum of four sessions in both the groups. Response in injected warts and distant warts was assessed at each visit and sequential clinical photographic records were maintained. Results: Thirty patients with positive mantoux reaction were enrolled for the trial, 17 patients in group A (PPD) and 13 patients in group B (BCG). Complete resolution of lesions was noted in 35.3% in PPD group and 30.8% in BCG group and partial resolution was noted in 47.0% and 38.4 % in PPD and BCG group respectively. Conclusion: Intralesional PPD showed marginally better results than intralesional BCG in the treatment of multiple cutaneous warts. Majority of the patients treated with BCG had tender nodule at injection site. Keywords: Immunotherapy, Multiple warts, Intralesional BCG, Intralesional PPD.

Rol de la fisioterapia en los cuidados paliativos

Introducción: Los cuidados paliativos son un enfoque realizado por un equipo multidisciplinario para mejorar la calidad de vida de los pacientes con enfermedad terminal y sus familias. Por otro lado, la fisioterapia favorece a la disminución deposibles discapacidades causadas por la enfermedad o sus tratamientos.
 Objetivo: Determinar el rol de la fisioterapia en los cuidados paliativos.
 Materiales y métodos:Revisión sistemática con análisis descriptivo y cronología retrospectiva. Se recaudó información sobre la población, grupos de intervención y control, tipología de la patología, intervención, período y frecuencia de intervención y resultados. Los estudios se identificaron y seleccionaron mediante las recomendaciones de la Declaración de PRISMA y la Colaboración Cochrane, además, se evaluó la calidad metodológica de los estudios incluidos en la revisión a través de la Escala de PEDro.
 Resultados: El equipo de fisioterapia se centra principalmente en un programa de ejercicios en el que no existe dosificación sobre el tipo, frecuencia, intensidad y la duración de los ejercicios que se deben administrar a los pacientes, ni tampoco en qué etapa de la enfermedad se debe administrar y de qué manera, la dosificación será individual y dependiendo en la etapa de la enfermedad.
 Conclusión: El papel principal del fisioterapeuta es el mantenimiento de la vida activa hasta la muerte, incentivar al paciente la actividad corporal y disminuir los síntomas causados por la enfermedad.

"I've found it's very meaningful work": Perspectives of physiotherapists providing palliative care in Ontario.

This study aimed to describe insights from interviews about the experience of physiotherapists providing palliative care in Ontario and their perceptions of the role and value of physiotherapists' involvement in palliative care. We conducted interviews with physiotherapists in Ontario, Canada (n = 14), and received emailed submissions from two others (one physiotherapist and one physiotherapy student) with current or recent practice experience in palliative care. We conducted inductive thematic analysis of the interview data and emailed submissions. Participants' reflections were categorized into three major themes: perceived value of the contribution of physiotherapists in palliative care; the experience of providing physiotherapy in palliative care; and reflections on the palliative care system. Participants described their role in palliative care as diverse, driven by patient goals and focused on the experience of patients and families. Participants perceived a high value in collaborative networks for supporting them to fulfill their role in palliative care settings. Participants also recommended efforts to increase awareness of the potential for physiotherapists to contribute to palliative care. The findings confirm those of research in other jurisdictions and extend our understanding of the value and meaningfulness of physiotherapy in palliative care, to patients, families, and physiotherapists themselves.

Physical Exercise: An Evaluation of a New Clinical Biomarker of Survival in Hospice Patients.

Survival analysis is an important issue in palliative care. However, there is a lack of quality clinical biomarkers for assessing survival, especially in bedridden patients. Recent research supports the benefit of physiotherapy in palliative care, as majority of hospice patients are able to perform physical therapy. We propose the hypothesis that the difference in activity during physical exercise can be used as a biomarker of survival in hospice care. We examined 536 consecutive patients who performed physical exercises in our hospice from March 2013 to July 2017. Univariate, multivariate, and Kaplan-Meier analysis were performed to explore the association between the level of physical exercise activity and survival. Physical exercises were performed by almost 70% of our hospice patients. The patients who initially performed active exercises lived longer, on average, compared to patients who only managed passive exercises (15 days vs 6 days, hazard ratio 0.60, 0.49-0.74). Surprisingly, the difference in survival based on the level of physical activity remained consistent regardless of the patient performance score, emphasizing its usefulness as an independent survival biomarker in a hospice setting. This tool also gave us an option to recognize a significant proportion of bedridden patients performing active exercises (30%), previously unrecognized using standard performance scales, exhibiting longer survival compared to others with the same performance score. Patients' level of activity during physical exercises has the potential to be a valuable new clinical biomarker in palliative care, whether used individually or combined with commonly used performance scales.

Physiotherapy in palliative oncology

Outreach multi-disciplinary palliative care teams have tended to duplicate hospital-based teams which historically have consisted almost exclusively of doctors and nurses. This paper outlines the role of physiotherapy in palliative care. It provides a conceptual framework for physiotherapy involvement and its potential to contribute within the palliative care team therapeutically and cost-effectively. To put physiotherapy management of the disease process into perspective, some basic data on terminal illness, and statistics of a Brisbane hospice, are included. The need for more outreach physiotherapy intervention is emphasised.