Physical Function in Hospice Patients and Physiotherapy Interventions: A Profile of Hospice Physiotherapy

Abstract

Objective: There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. Design: The study design consisted of a retrospective chart audit over 6 months. Setting: The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. Participants: All patients were discharged (through death or discharge onwards) from January to June 2010. Outcome measure: The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Results: Sixty-five percent were referred for physiotherapy; 58% (n = 144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. Conclusion: There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life/supportive measures. The most common treatments were physical activity interventions.

Palliative Care Edema: Patient Population, Causal Factors, and Types of Edema Referred to a Specialist Palliative Care Edema Service

“…The high prevalence of patients with cancer (92%) is similar to general physiotherapy studies at our center, 26,27 being proportionate to the overall population in our facility. This suggests that both cancer and noncancer diagnoses may cause edema proportionately in palliative care patients.…”

The Changing Nature of Palliative Care: Implications for Allied Health Professionals’ Educational and Training Needs

“…They can provide non-pharmacological symptom control options alongside pharmacological interventions. Their care approaches enable continuing participation in essential and valued daily activities [3,4]. Allied health interventions do not focus on curative care, rather they focus on optimising function for as long as possible and on identification of patient priorities at this time of their life.…”

Die Rolle der Physiotherapie auf Palliativstationen – Ergebnisse einer qualitativen Untersuchung

“…Neben der relativ breit erforschten Effektivität der Manuellen Lymphdrainage bei Lymphödemen [8 -10], lassen erste Studien darauf schließen, dass physiotherapeutische Interventionen in der Palliativversorgung wesentlich zum Erhalt der Mobilität [11 -14], zur Linderung von Fatigue [15,16], Schmerzen und Beeinträchtigungen der Stimmungslage bei Tumorpatienten [17] sowie zur Linderung von Luftnot bei Patienten im fortgeschrittenen Stadium maligner und nicht maligner Lungenerkrankungen [18] beitragen können. Vergleichbare Effekte zeichnen sich auch in Untersuchungen unter Hospizpatienten ab [19,20]. Bislang ist allerdings über die tatsächliche Rolle der Physiotherapie und ihre Potenziale, aber auch über mögliche Barrieren bei der Umsetzung insbesondere in der palliativen Versorgungspraxis in Deutschland wenig bekannt [7].…”