Every Monday you will find a high-quality research study here on Physiospot that has been summarized for you. The articles are chosen because they are of high quality, impact and likely to shape your clinical practice. After all, it is difficult to find the gemstones in all of the research published daily. Let us do the hard work for you.
It can be difficult to understand the role and scope of a physical therapist who works in a hospice. For many clinicians, it is an unfamiliar environment to work in and it can be difficult to intuitively understand and apply the traditional role of our profession. Traditional physical therapy education will ensure you know how to red flag cancer but not how to improve the quality of life for those nearing their final months of life.
This systematic review dealt with the following questions:
What different physiotherapy interventions address the symptoms of patients with advanced cancer in a hospice?
What are the characteristics (dose, duration, type and intensity) and effects of physiotherapy interventions in this setting?
This was achieved by performing a systematic review that conformed to PRISMA and using a thorough search strategy, as well as a modified down and black checklist for the methodological accuracy of the included studies. Initially, 2102 articles were obtained using the search strategy and these were reduced to 9 articles. The methodology is clear and easy to understand throughout the article. Overall, the studies included were of poor to moderate quality, but this is often the case in studies like this due to high dropout rates (in this case death), inability to conduct RCTs (limitations in this population), and small sample sizes. That being said, there is no excuse for posting an article with missing data and this has been the case with several articles that were included in the review.
The results
Physical function
The symptoms that patients with advanced cancer suffer from lead to reduced physical performance due to reduced strength and endurance, which reduces independence. The results of the systematic review suggest that a structured training intervention should help improve physical function and maintenance rather than focus on progression. The optimal type of movement is unclear. This is probably due to the lack of heterogeneity in the patient group.
Fatigue
There are many factors influencing fatigue in this population, including; Insomnia, anemia, inflammation and pain. The results of this review suggest that cardiovascular and strength training were effective at reducing the intensity of fatigue.
Pain
Approximately 66.4% of patients with advanced cancer experience pain, and this systematic review suggests that TEN, along with opiates, is an effective and viable pain management strategy at this stage of cancer. Physiotherapy intervention should only be seen as a complement.
Lymphodema
Compression bandaging and massage are known effective management techniques for lymphodema and this should be continued.
Clinical implications
This systematic overview shows the scope and role of physiotherapy in a hospice and how we can help patients achieve as much quality of life as possible in the last months of their lives. Overall structured movement, therapeutic massage, TENs and compression bandages for lymphodema are worthwhile measures that can be used in this environment to improve the quality of life.
An Introduction to Red Flags
When evaluating patients in clinical practice, it is always important to consider a serious pathology as a differential diagnosis. Red flag screening questions have been developed to identify these pathologies. However, there is limited evidence for their use. How should clinicians use red flags and how do they know when to take action? This course is designed to give you an understanding of the red flags and how they can be used effectively in clinical practice.
Do you know how to look for red flags?
