Safety and Feasibility of Rehabilitation Interventions in Children Undergoing Hematopoietic Stem Cell Transplant With Thrombocytopenia

Abstract

Objective: To analyze the relationship between platelet counts, the intensities of physical therapies (PT) and occupational therapies (OT) services received, and the frequency of bleeding complications in children undergoing hematopoietic stem cell transplants (HSCT) during a period of severe thrombocytopenia. Design: Retrospective review study Setting: Tertiary care hospital Participants: Children (age <18) hospitalized for HSCT in 2010 and 2011 who received PT and OT services while markedly thrombocytopenic (platelets≤50K/mcL). Interventions: None Main Outcome Measures: Intensities of PT and OT interventions, the patients’ platelet counts on specific therapy days and any bleeding events (minor or major) that occurred during or briefly following rehabilitation interventions. Results: Sixty-two patients (accounting for sixty-three HSCTs) met the criteria for analysis. Fifty-six of these patients (fifty-seven HSCTs) underwent PT and/or OT while markedly thrombocytopenic. There was no correlation between the platelet count and the intensity of rehabilitation interventions. There were no major bleeding events. There was no association between minor bleeding and intensities of PT or OT interventions and no association between minor bleeding events and platelet counts. Only 5 minor bleeding events occurred during or following moderate or intensive therapy out of 346 PT and OT sessions (1.5%). Conclusion: The results of our study suggest that bleeding complications during or following mobilization and supervised exercise during PT and OT in children with severe thrombocytopenia undergoing HSCT are minor and relatively rare. These are encouraging results for both patients and rehabilitation specialists treating this population who is at high risk for developing immobility related complications.

Should healthcare organisations offer ongoing rehabilitation services for patients undergoing haematopoietic cell transplant? A narrative review

“…Despite discrepancies in the quality of the trials, type of intervention, and methodology, none of the studies included in this review mentioned an adverse event as a direct result of rehabilitation exercise intervention. This finding is in line with other studies, where the children with severe thrombocytopenia undergoing HSCT were found to have only minor and relatively rare bleeding complications due to physical and occupational therapy interventions (Ibanez et al, 2018). Furthermore, the majority of the previous systematic reviews, despite eluding to the need for more robust clinical trials, have agreed that exercise is safe and has a positive impact on patients' physical function, HRQoL, and fatigue (Persoon et al, 2013;Van Haren et al, 2013;Kruijsen-Jaarsma et al, 2013;Oberoi et al, 2018…”

Exercise in cirrhosis: Translating evidence and experience to practice

“…Studies in patients with acute brain injury, dementia, and serious mental illness support the efficacy and feasibility of exercise despite cognitive issues. [49][50][51] Although thrombocytopenia is not considered a contraindication to exercise, in keeping with data in stem cell transplant patients, 52 exercises with high risk of injury or falling should be avoided, especially if platelets are <20,000/ll.…”

Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report

“…Normally, a platelet count less than 20,000/mL would be considered as a relative contraindication for exercises, whereas patients with platelet counts between 20,000 and 30,000/mL could perform gentle nonresistance exercises, 30,000 to 50,000/mL minimal resistance (1 to 2 pound) exercises, 50,000 to 150,000/mL progressive resisted exercises, and 150,000/mL and beyond no restrictions [51]. There is, however, growing evidence that even with critically low platelets (10,000 to 50,000 /mL), patients can perform carefully designed exercises without any additional risk factors, if they are monitored and supervised by an experienced therapist [52,53].…”