Physical Therapy Utilization Among Hospitalized Patients With Pediatric Acute Lymphoblastic Leukemia

Abstract

PURPOSE: Patients with pediatric acute lymphoblastic leukemia (ALL) are at risk for impaired physical function from treatment. Early physical therapy (PT) may improve physical function and health in children with ALL, yet little is known about PT utilization in this population. METHODS: Leveraging the Premier Healthcare Database, we conducted a cohort study including participants hospitalized with ALL at age 0-21 years from January 1, 2010, through March 31, 2017. A generalized mixed linear model assessed sociodemographic and clinical variables associated with receiving PT within 1 year of first hospitalization. RESULTS: Among 5,488 pediatric ALL patients from 330 hospitals (median age 7 years, interquartile range = 4-14 years), only 27.2% overall and 58.9% with neuromuscular conditions received PT within a year of first ALL admission. In multivariable analysis, patients more likely to receive PT were age 10-14 years (odds ratio [OR] = 1.46; 95% CI, 1.20 to 1.76) or 15-21 years (OR = 1.66; 95% CI, 1.36 to 2.02) versus 0-4 years and Hispanic (OR = 1.27; 95% CI, 1.04 to 1.56) versus White. Patients less likely to receive PT were treated by a nonhematology/oncology pediatric (OR = 0.56; 95% CI, 0.46 to 0.70) or adult (OR = 0.50; 95% CI, 0.38 to 0.65) specialist versus a pediatric hematologist/oncologist and treated at a nonteaching hospital (OR = 0.53; 95% CI, 0.36 to 0.79) versus a teaching hospital. CONCLUSION: Only 27.2% of pediatric ALL patients overall and 58.9% with neuromuscular conditions receive inpatient PT within a year of first ALL admission. Interventions to increase inpatient PT services to pediatric ALL patients and address disparities in PT utilization may improve the physical function and long-term health of survivors.

Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review

“…Guideline‐concordant care and further development of pediatric oncology rehabilitation guidelines are critical to enhancing the care and outcomes of children with cancer. Given the challenges with pediatric oncology supportive care guideline adherence, 62 the often low rates of rehabilitation use among this population, 20,22,23 and the lack of available, comprehensive pediatric oncology rehabilitation programs, 22 it is suspected that adherence is suboptimal. Adhering to guidelines may increase the number of children referred to rehabilitation and can support equity in how rehabilitation services are provided within pediatric oncology.…”

“…Across 330 US hospitals, only 27% of children diagnosed with acute lymphoblastic leukemia (ALL) received inpatient physical therapy (PT) within 1 year of diagnosis. 20 In contrast, at a single institution with specific pediatric oncology rehabilitation programing, 96% of children with ALL received inpatient PT within a year of diagnosis. 21 Access to care also differs based on diagnosis and rehabilitation service, with speech therapy typically having the lowest utilization rates (range, 4%-10%).…”

“…However, the current state of access to rehabilitation services among CCS is highly variable in the published research. Across 330 US hospitals, only 27% of children diagnosed with acute lymphoblastic leukemia (ALL) received inpatient physical therapy (PT) within 1 year of diagnosis 20 . In contrast, at a single institution with specific pediatric oncology rehabilitation programing, 96% of children with ALL received inpatient PT within a year of diagnosis 21 .…”

Assessment of proxy‐reported responses as predictors of motor and sensory peripheral neuropathy in children with B‐lymphoblastic leukemia

“…Chemotherapy-induced peripheral neuropathy (CIPN), a common vincristine-related toxicity in children with acute lymphoblastic leukemia (ALL), [1][2][3][4][5] can present with lasting motor and sensory deficits, including impaired strength, joint range of motion (ROM), gait, and sensation, and can continue to impact the long-term health of childhood cancer survivors. [6][7][8][9] Early identification of CIPN can lead to physical or occupational therapist (PT/OT) referral to mitigate symptoms and improve function, [10][11][12] but in practice up to 80% of cases are missed until survivorship care. 13 A major challenge in identifying CIPN in young children is the absence of a generalizable screening instrument that can be incorporated into routine oncology care.…”

Effect of Early Physical Therapy on Children of School Age With Hematological Cancer: A Quasi-Randomized Controlled Pilot Study

“…17 However, the use of PT for childhood hematological cancers remains underresearched as compared with PT for solid tumors, such as brain tumors and osteosarcoma. 18 Research supports the feasibility and efficacy of PT interventions for children with hematological cancer, particularly for muscular strengthening, during treatment 16 ; however, there is insufficient evidence on the optimal PT characteristics (ie, exercise type and intensity) for favorable clinical outcomes. 12,19 Preventive PT is necessary to manage physical conditioning in children placed on bed rest.…”