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Aug 16, 2019

EFIC Congress 2019 - Pain in Europe XI

END OF LIFE CARE: ROLE OF PHYSICAL THERAPY INTERVENTION WITHIN HOSPICE PALLIATIVE CARE

Hospice

Palliative Care

Exercise

Palliative Rehabilitation

Physical Therapy

Interdisciplinary

End of Life

Quality of Life

osteopathy

Abstract

Abstract

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Keywords

Hospice

Palliative Care

Exercise

Palliative Rehabilitation

Physical Therapy

Interdisciplinary

End of Life

Quality of Life

osteopathy

Abstract

Background Palliative care (PC) and best Supportive Care are complex areas to promote and advance. Many people need and benefit from them, therefore education, spreading knowledge and existence of interdisciplinary teams (IDT) are required to ensure best quality of life. Nowadays only 15% of Countries have Hospice and Palliative Care (HPC) integrated inside their national health system. Among those countries, few offer physical therapies. Complementary and other non-pharmacological strategies used alongside traditional analgesic approach aims to help patients in maintaining and improving functionality in order to obtain at the same time psychological benefits. Physical therapies (PT) are part of a no pharmacological approach, including several different techniques applied by physical therapists (PTs) with the purpose not only to manage the symptoms but also to improve Quality Of Life (QOL) of patients receiving pain rehabilitation and palliative care. It allows PTs to be part of an IDT and being active part of the holistic care of the patient. Aims Linking PC with physical rehabilitation or physical exercise (PE), the aim was to critically evaluate the evidence for the effectiveness, benefits and weaknesses of PT (exercise) in end-of-life care. Due to the results obtained and the strength of the evidence, the author suggests a first protocol involving an IDT to best fit the evidence. Methods A systematic review has been conducted, screening and reviewing the most recent studies published and related to this topic. More than 10 among databases and journals has been investigated to answer the aim. Results Eight studies fitted for the analysis discussing the role of physical therapy intervention in palliative care setting. The quality of the studies was done following QASP/CASP checklists. Improvements (p ≤ 0.01) were observed in physical performance, fatigue, and overall quality-of-life scores. A first physical exercise programme is suggested. Conclusions An holistic biopsychosocial intervention (Total Pain concept) is the key for those people with complex and life-threatening illnesses. Not only for patients but also for the caregivers underlying the importance of a IDT. PTs play an important role inside a team focusing their intervention in improving functionality and QOL turning to physical and functional dimensions of care. Around 75% of the population will need PC therefore it is indispensable to start offering i) the best services, ii) where patients want, iii) taking the best decisions (right care, right place, right time). PT/PE plan has to be tailor-made and based on the general prospective evolution of the patient, in his capability to recover his functionality and his desire to take part to the rehabilitation programme. References: Chong Guan, N., Kiah Tian, L., Seng Beng, T., Ahmad Hatim, S. and Nor Zuraida, Z. (2016). The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study. Journal of Palliative Medicine 19:917. IASP. (2009). Global Year Against Cancer Pain. IASP: International Association for the Study of Pain. Jensen, W., Bialy, L., Ketels, G., Freerk T. Baumann, F. T. and Bokemeyer, C. (2014). Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis. Supportive Care in Cancer 22:1261-1268. Litterini, A. J., Fieler, V. K., Cavanaugh, J. T. and Lee, J. Q. (2013). Differential effects of cardiovascular and resistance exercise on functional mobility in individuals with advanced cancer: a randomized trial. Arch Phys Med Rehabil 94:2329-2335. Malcolm, L., Mein, G., Jones, A., Talbot-Rice, H., Maddocks, M. and Bristowe, K. (2016). Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliative Care 15:97. McGrillen, K. and McCorry, N. (2014). A physical exercise programme for palliative care patients in a clinical setting: Observations and preliminary findings. Progress in Palliative Care 22:352-358. Putt, K., Faville, K. A., Lewis, D., McAllister, K., Pietro, M. and Radwan, A. (2017). Role of Physical Therapy Intervention in Patients With Life-Threatening Illnesses. Am J Hosp Palliat Care 34:186-196. Saunders, C. (1993). The Management of Terminal Malignant Disease. Edward Arnold, p. 305. Talbot Rice, H., Malcolm, L., Norman, K., Jones, A., Lee, K., Preston, G., McKenzie, D. et al. (2014). An evaluation of the St Christopher's Hospice rehabilitation gym circuits classes: Patient uptake, outcomes, and feedback. Progress in Palliative Care 22:319-326. Turner, F., Seiger, C. and Devine, N. (2013). Impact of patient and caregiver transfer training provided by a physical therapist in the hospice setting: a case study. Am J Hosp Palliat Care 30:204-209. Wilson, C. M., Stiller, C. H., Doherty, D. J. and Thompson, K. A. (2017). The Role of Physical Therapists Within Hospice and Palliative Care in the United States and Canada. Am J Hosp Palliat Care 34:34-41.

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All rights reserved.