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Physical and Occupational Therapy in Palliative Care

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Essentials of Palliative Care

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Abstract

Rehabilitation in palliative care addresses physical limitations caused either by a severely debilitating or life-threatening illness. Physical limitations may be caused by tumor mass effects or by the treatments used for palliation of that illness. Palliative rehabilitation can be divided into three categories: preventative, restorative, and supportive. Preventative rehabilitation attempts to address and prevent functional decline by addressing and correcting morbidity caused by cancer or its treatment. When long-term impairment can be avoided, restorative rehabilitation attempts to return patients to their premorbid functional status. Supportive rehabilitation attempts to maximize function after permanent impairments caused by cancer and/or its treatment [Javier and Montagnini. J Palliat Med. 14(5):638–648, 2011].

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References

  1. Javier NS, Montagnini ML. Rehabilitation of the hospice and palliative care patient. J Palliat Med. 2011;14(5):638–48. doi:10.1089/jpm.2010.0125.

    Article  PubMed  Google Scholar 

  2. Montagnini M, Lodhi M, Born W. The utilization of physical therapy in a palliative care unit. J Palliat Med. 2003;6:11–7.

    Article  PubMed  Google Scholar 

  3. Lowe SS, Watanabe SM, Baracos VE, Courneya KS. Physical activity interests and preferences in palliative cancer patients. Support Care Cancer. 2010;18(11):1469–75.

    Article  PubMed  Google Scholar 

  4. Lowe SS, Watanabe SM, Courneya KS. Associations between physical activity and quality of life in palliative cancer patients: a pilot survey. J Pain Symptom Manage. 2009;38(5):785–96.

    Article  PubMed  Google Scholar 

  5. Motl RW, McAuley E. Pathways between physical activity and quality of life in adults with multiple sclerosis. Health Psychol. 2009;28:682–9.

    Article  PubMed  Google Scholar 

  6. Motl RW, McAuley E, Snook EM. Physical activity and quality of life in multiple sclerosis: possible roles of social support, self-efficacy and functional limitations. Rehabil Psychol. 2007;52:143–51.

    Article  Google Scholar 

  7. Ginis KA, Latimer AE, McKechnie K, Ditor DS, McCartney N, Hicks AL, et al. Using exercise to enhance subjective well-being among people with spinal cord injury: the mediating influences of stress and pain. Rehabil Psychol. 2003;48:157–64.

    Article  Google Scholar 

  8. Katz JF, Adler JC, Mazzarella NJ, Ince LP. Psychological consequences of an exercise training program for a paraplegic man. Rehabil Psychol. 1985;30:53–8.

    Google Scholar 

  9. Nayak S, Wheeler BL, Shiflett SC, Agostinelli S. Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke. Rehabil Psychol. 2000;45:274–83.

    Article  Google Scholar 

  10. Holmes PS. Theoretical and practical problems for imagery in stroke rehabilitation: an observation solution. Rehabil Psychol. 2007;52:1–10.

    Article  Google Scholar 

  11. Lanken PN, Terry PB, DeLisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, et al. An official American Thoracic Society policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177:912–27.

    Article  PubMed  Google Scholar 

  12. LeGrand SB. Dyspnea: the continuing challenge of palliative management. Curr Opin Oncol. 2002;14:394–8.

    Article  PubMed  Google Scholar 

  13. Harding R, Karus D, Easterbrook P, Raveis VH, Higginson IJ, Marconi K. Does palliative care improve outcomes for patients with HIV/AIDS: a systematic review of the evidence. Sex Transm Infect. 2005;81:5–14.

    Article  PubMed  CAS  Google Scholar 

  14. Cade WT, Peralta L, Keyser RE. Aerobic exercise dysfunction in human immunodeficiency virus: a potential link to physical disability. Phys Ther. 2004;84:655–64.

    PubMed  Google Scholar 

  15. Nixon S, O’Brien K, Glazier R, Tynan AM. Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev. 2005;(2):CD001796.

    Google Scholar 

  16. O’Brien K, Nixon S, Tynan AM, Glazier RH. Effectiveness of aerobic exercise in adults living with HIV/AIDS: systematic review. Med Sci Sports Exerc. 2004;36:1659–66.

    Article  PubMed  Google Scholar 

  17. O’Brien K, Nixon S, Glazier R, Tynan AM. Progressive resistive exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev. 2004;(4):CD004248.

    Google Scholar 

  18. O’Brien K, Tynan AM, Nixon S, Glazier RH. Effects of progressive resistive exercise in adults living with HIV/AIDS: systematic review and meta-analysis of randomized trials. AIDS Care. 2008;20:631–53.

    Article  PubMed  Google Scholar 

  19. Yoshioka H. Rehabilitation for the terminal cancer patient. Am J Phys Med Rehabil. 1994;73:199–206.

    Article  PubMed  CAS  Google Scholar 

  20. Sabers SR, Kokal JE, Girardi JC, Philpott CL, Basford JR, Therneau TM, Schmidt KD, Gamble GL. Evaluation of consultation-based rehabilitation for hospitalized cancer patients with functional impairment. Mayo Clin Proc. 1999;74:855–61.

    Article  PubMed  CAS  Google Scholar 

  21. Strasser F. Diagnostic criteria of cachexia and their assessment: decreased muscle strength and fatigue. Curr Opin Clin Nutr Metab Care. 2008;11(4):417–21.

    Article  PubMed  Google Scholar 

  22. Kumar SP, Anand J. Physical therapy in palliative care: from symptom control to quality of life: a critical review. Indian J Palliat Care. 2010;16:138–46.

    Article  PubMed  Google Scholar 

  23. Dworzak F, Ferrari P, Gavazzi C, et al. Effects of cachexia due to cancer on whole body and skeletal muscle protein turnover. Cancer. 1998;82:42–8.

    Article  PubMed  CAS  Google Scholar 

  24. Oettle H, Richards D, Ramanathan RK, et al. A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann Oncol. 2005;16:1639–45.

    Article  PubMed  CAS  Google Scholar 

  25. Colson K, Doss DS, Swift R, et al. Bortezomib, a newly approved proteasome inhibitor for the treatment of multiple myeloma: nursing implications. Clin J Oncol Nurs. 2004;8:473–80.

    Article  PubMed  Google Scholar 

  26. Schrag D, Chung KY, Flombaum C, Saltz L. Cetuximab therapy and symptomatic hypomagnesemia. J Natl Cancer Inst. 2005;97:1221–4.

    Article  PubMed  CAS  Google Scholar 

  27. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health: a recommendation from the centers for disease control and prevention and the American college of sports medicine. J Am Med Assoc. 1995;273:402–7.

    Article  CAS  Google Scholar 

  28. Bryan A, Hutchinson KE, Seals DR, Allen DL. A transdisciplinary model integrating genetic, physiological and psychological correlates of voluntary exercise. Health Psychol. 2007;26:30–9.

    Article  PubMed  Google Scholar 

  29. Borgsteede SD, Deliens L, Francke AL, et al. Defining the patient population: one of the problems for palliative care research. Palliat Med. 2006;20:63–8.

    Article  PubMed  Google Scholar 

  30. Kumar SP, Jim A. Physical therapy in palliative care: from symptom control to quality of life: a critical review. Indian J Palliat Care. 2010;16(3):138–46.

    Article  PubMed  Google Scholar 

  31. Lyles JN, Burish TG, Krozely MG, Oldham RK. Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. J Consult Clin Psychol. 1982;50:509–24.

    Article  PubMed  CAS  Google Scholar 

  32. Jones LW, Courneya KS. Exercise counseling and programming preferences of cancer patients. Cancer Pract. 2002;10(4):208–15.

    Article  PubMed  Google Scholar 

  33. Segal RJ, Reid RD, Courneya KS, et al. Resistance exercise in med receiving androgen deprivation therapy for prostate cancer. J Clin Oncol. 2003;21:1653–9.

    Article  PubMed  Google Scholar 

  34. Dimeo F, Fetscher S, Lange W, et al. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood. 1997;90:3390–4.

    PubMed  CAS  Google Scholar 

  35. Chan DN, Lui LY, So WK. Effectiveness of exercise programmes on shoulder mobility and lymphedema after axillary lymph node dissection for breast cancer: systemic review. J Adv Nurs. 2010;66(9):1902–14.

    PubMed  Google Scholar 

  36. Ko DS, Lerner R, Klose G, et al. Effective treatment of lymphedema of the extremities. Arch Surg. 1998;133:452–8.

    Article  PubMed  CAS  Google Scholar 

  37. Moseley AL, Carati CJ, Pillar NB. A systemic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18(4):639–46.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, CA, USA

    Kais Alsharif M.D. & Justin Hata M.D.

Authors
  1. Kais Alsharif M.D.
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  2. Justin Hata M.D.
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Corresponding author

Correspondence to Kais Alsharif M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    The most common complaint experienced by cancer patients resulting in decreased physical function is?

    1. (a)

      Pain

    2. (b)

      Depression

    3. (c)

      Fatigue

    4. (d)

      Weakness

  2. 2.

    Which of the following are physiologic changes contributing to fatigue in the palliative patient?

    1. (a)

      Alteration in, or decrease in ATP

    2. (b)

      Tumor load resulting in tumor proinflammatory cytokine production, including interleukin-1, interleukin-6, and tumor necrosis factor-α

    3. (c)

      Alterations in muscle metabolism

    4. (d)

      All of the above are true

  3. 3.

    Physical modalities for pain control include all except?

    1. (a)

      Massage

    2. (b)

      Heat/cold

    3. (c)

      Ultrasound

    4. (d)

      Transcutaneous electrical nerve stimulation (TENS)

    5. (e)

      Epidural injection

  4. 4.

    Regarding breast cancer rehabilitation following lumpectomy, axillary lymph node dissection or modified radical mastectomy, which of the following is true?

    1. (a)

      Early rehabilitation is associated with seroma formation and is discouraged

    2. (b)

      Rehab usually begins 2–3 months following surgery

    3. (c)

      Early rehabilitation results in better outcomes and is not associated with postoperative seroma formation

    4. (d)

      None of the above are true

  5. 5.

    Which of the following is true regarding axillary web syndrome?

    1. (a)

      It is a congenital disorder

    2. (b)

      It is a taut palpable cord in the axilla occurring following lymph node dissection

    3. (c)

      It does not respond to manual therapy

    4. (d)

      It is a vascular malformation of the axillary artery

  6. 6.

    A 78-year-old female with history of metastatic breast cancer on hospice care is having difficulty reaching for objects in her kitchen, as well as more frequent falls at home. Which of the following can an occupational therapist help with?

    1. (a)

      Environmental modification such as removal of throw rugs to prevent falls, addition of railing to staircase, etc.

    2. (b)

      Evaluating for adaptive equipment such as a reacher

    3. (c)

      Providing a high stool in the kitchen

    4. (d)

      Providing a cane or walker to assist with ambulation

    5. (e)

      All of the above

  7. 7.

    Which of the following are essential to a successful evaluation of a palliative patients’ rehabilitation needs?

    1. (a)

      Close attention to the neurologic and musculoskeletal systems

    2. (b)

      Awareness of previous therapies and treatments received

    3. (c)

      Information on pathology location, staging, estimated life expectancy, and other comorbidities

    4. (d)

      Adequate pain evaluation and treatment

    5. (e)

      All of the above

  8. 8.

    What is subacute rehabilitation?

    1. (a)

      An outpatient rehab program for palliative patients

    2. (b)

      An inpatient program for patients who can tolerate at least 3 h of vigorous physical and occupational therapy

    3. (c)

      Slow paced rehab, often at a skilled nursing facility which provides less intense rehabilitation for patients who can tolerate at least 1 h each day, but less than 3 h

    4. (d)

      Another name for a nursing home

  9.  9.

    All of the following are true, except:

    1. (a)

      There is evidence to suggest that therapy referrals are uncommon and underutilized in the palliative care setting

    2. (b)

      Palliative care patients are not interested and feel unable or unwilling to undergo therapy

    3. (c)

      There is strong evidence that physical activity has a significant positive impact on the quality of life in palliative patients with advanced cancer, multiple sclerosis, Alzheimer’s disease, spinal cord injury, brain injury, cardiopulmanry disease, and HIV

    4. (d)

      There is strong evidence that hospice patients show decreased pain, dyspnea, leg edema and better mood, motor function, cognitive function from admission to discharge as well as increased mobility and better quality of life

  10. 10.

    Rehabilitation in the palliative setting is associated with all of the following except:

    1. (a)

      Maintaining optimum respiratory and circulatory function

    2. (b)

      Preventing muscle atrophy

    3. (c)

      Preventing joint contractures

    4. (d)

      Prolonging life expectancy

    5. (e)

      Improving pain control

    6. (f)

      Optimizing independence and function

Answers

  1. 1.

    (c) Fatigue

  2. 2.

    (d) All of the above are true

  3. 3.

    (e) Epidural injection

  4. 4.

    (c) Early rehabilitation results in better outcomes and is not associated with postoperative seroma formation

  5. 5.

    (b) It is a taut palpable cord in the axilla occurring following lymph node dissection

  6. 6.

    (e) All of the above

  7. 7.

    (e) All of the above

  8. 8.

    (c) Slow paced rehab, often at a skilled nursing facility which provides less intense rehabilitation for patients who can tolerate at least 1 h each day, but less than 3 h

  9. 9.

    (b) Palliative care patients are not interested and feel unable or unwilling to undergo therapy

  10. 10.

    (d) Prolonging life expectancy

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Alsharif, K., Hata, J. (2013). Physical and Occupational Therapy in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_10

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_10

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

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