WHO Collaborating Centre for Palliative Care, Policy and Rehabilitation When to involve physiotherapy in palliative care? Matthew Maddocks NIHR Post-Doctoral Research Fellow Eva Müllauer Specialist Physiotherapist
Session outline scene setting / rationale for early intervention examples of proactive clinical practice discussion and questions close and response
Late contact limits what physiotherapy can offer often surrounded by difficult circumstances lack of background on the therapist s side can limit patient confidence lack of time leads to crisis management / reactive palliation of symptoms not a good basis for quality physiotherapy in palliative care
Proactive intervention often low symptom burden, so focus is on empowerment and self-management treatments can be completed at home, e.g. airway clearance, exercise physiotherapist becomes a partner a therapeutic relationship can be built, leading to trust and confidence
COPD, CF, pulmonary fibrosis early disease: focus on empowerment, e.g chest clearance, pulmonary rehabilitation, symptom prevention late disease: symptom management, pacing, maintenance of independence, exacerbation management end-stage disease: symptom relief, hands-on management, e.g. NIV, massage, transfers. Reliance on trust and knowledge of the patient
Thoracic cancer late presentation, high symptom burden, poor prognosis, unstable trajectory intensive medical treatment high incidence of cachexia leading to increased morbidity and mortality
Lung cancer CARE service dedicated to people with thoracic cancer particular focus on the effects of cachexia emphasis on maximising function and independence integrated with lung cancer and specialist palliative care services
Top 10 symptoms or issues Percentage [95% CI] of patients reporting 'very much' or 'quite a bit' of distress or bother Feeling tired 51 [47 55] Shortness of breath 49 [45 53] Concern about effects of illness on family 40 [37 44] Change in weight 40 [36 44] Problems sleeping at night 39 [35 43] Cough 37 [33 41] Feeling sleepy during the day 36 [32 40] Loss of appetite 35 [32 39] Pain 34 [31 38] Feeling anxious 34 [30 37]
Rehab needs and interventions (PT) screened using SPARC questionnaire: SOB, Cough, Pain, Feeling weak, Loss independence, Changes in ability to carry out activities of daily living ~1/2 warranted full physiotherapy assessment 270 patients, median 2 [1 3] problems / interventions per patient mainly mobility, breathing control.
Summary Early physiotherapy intervention allows: timely assessment of needs treatments that improve patient self-efficacy a full range of supportive interventions scope to build up a therapeutic relationship All are essential to maximise the benefit of physiotherapy in a palliative care setting
Discussion statements physiotherapy can never start too early early intervention requires an all-or-nothing approach proactive interventions are always better than reactive ones patients with cancer are the most likely to want early intervention
Acknowledgments EAPC Physiotherapy Taskforce in particular Jacob van den Broek and José Weststrate Austrian Physiotherapy Association National Institute of Health Research Macmillan Cancer Support http://www.networks.nhs.uk/nhs-networks/cancer-rehabilitationforum/reports/annual%20report%20care%20october%202009-2011_final_120404_aw.pdf