Transcript Role of physiotherapy in the rehabilitation of palliative

Role of physiotherapy in the
rehabilitation of palliative care
patients
Caroline Belchamber Senior Oncology Physiotherapist
Catherine Everett Senior Macmillan Physiotherapist
August 2006
Aims
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To be aware of the concept of rehabilitation in
palliative care and the NICE guidelines on
supportive and palliative care
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To understand the role of palliative care
physiotherapists
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To be aware of the physiotherapy service for
palliative care patients at Poole Hospital
NICE Guidelines
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The rehabilitation needs for patients should be
assessed at key points in the patient pathway
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Cancer rehabilitation attempts to maximise
patients ability to function, to promote their
independence and to help them to adapt to their
condition
Rehabilitation
‘To minimise some of the effects which the
disease, or it’s treatment has on them. It is
often possible to improve the quality of life
regardless of their prognosis by helping
them to achieve their maximum potential of
functional ability and independence or gain
relief from distressing symptoms’
ACPOPC 1993
The role of the physiotherapist
in palliative care
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Physiotherapists work with respiratory,
neurological, lymphatic, orthopaedic,
musculoskeletal, pain and haemotalogical
conditions
 Education and training of MDT as well as patients
and carers
 Dissemination of information to MDT with key
role in discharge planning
 Communication and collaboration between
primary and secondary care
Physiotherapy interventions
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Positioning – prevention of pressure sores
TENS – pain and nausea control
Respiratory care – Non-pharmacological approach
and prevention of retained secretions and oxygen
therapy
Neurological rehabilitation – e.g SCC, Brain
tumours and peripheral neuropathies
Mobility – Exercise tolerance, maintenance and
independence
Passive/active range of movement – prevention of
contractures
Individual exercise programmes
Poole hospital physiotherapy
palliative care service
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In-patient palliative care service
Two wards with 41 beds
On average 30 patients requiring physio a week
0.6 FTE Oncology physiotherapist since May
2003
FTE Macmillan physiotherapist since June 2005
Expanding palliative care physiotherapy service
Rehabilitation slots introduced in August 2005
Case Study

61 year old male SCC
 Presented with decreased mobility with pain
in right shoulder
 PMH – Ca prostate
 MRI – 24th Feb cord compression at T2
with extensive disease to T1, T2 and L3
 Physiotherapy assessment
 Physiotherapy management
Conclusion
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AHP and their role needs to be recognised
in this specialist area of rehabilitation
 AHP give ‘control’ back to palliative care
patients
 AHP increase palliative care patients QOL
 Rehabilitation commences from time of
diagnosis through the whole cancer
trajectory
‘With in the context of palliative care, realistic
joint goal setting gives the patient a measure
of control, often at a time when they are
experiencing helplessness and loss of
independence’
Robinson 2000
References
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NICE guidelines: Supportive and palliative care:
Chapter 10: DOH 2004
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Jollife, J and Bury (2000). The effectiveness of
physiotherapy in palliative care of older people,
CSP.
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Role of physiotherapy in palliative care ACPOPC
2003