The role of physiotherapy in palliative care.

An unpublished chart audit at a major Australian tertiary teaching BLOCKINhospital BLOCKINreveals BLOCKINthat BLOCKINdespite BLOCKIN65% BLOCKINof BLOCKINcancer BLOCKINpatients (inpatients or at outpatient oncology clinics) presenting with specific indications for physiotherapy, only 12.8% were receiving physiotherapy. 1 Indications included pain, lymphoedema, incontinence, respiratory dysfunction and musculoskeletal BLOCKINproblems BLOCKINincluding BLOCKINdifficulty BLOCKINwith BLOCKINmobility. Although it is typically thought of as such, palliative care should not be limited to the end stage of life. A palliative approach to care can begin much earlier and can be applied not only to conditions usually considered for palliation BLOCKIN(typically BLOCKINcancer) BLOCKINbut BLOCKINalso BLOCKINto BLOCKINchronic BLOCKINand BLOCKINdebilitating neuromuscular disorders, cardiothoracic diseases, and HIV and BLOCKINAIDS. In cancer care, formalised physiotherapy involvement dates back to the 1960s – before the commencement of the modern hospice movement – and was confined to restoration BLOCKINdirected BLOCKINat BLOCKINthose BLOCKINpatients BLOCKINwith BLOCKINa BLOCKINrelatively BLOCKINstable or BLOCKINencouraging BLOCKINprognosis. 2 Today, the involvement of physiotherapists in the field of BLOCKINoncology BLOCKINis BLOCKINdiverse BLOCKINand BLOCKINincludes BLOCKINspecific BLOCKINroles BLOCKINwhich BLOCKINare evidence BLOCKINbased BLOCKINand BLOCKINcommonly BLOCKINapplicable, BLOCKINincluding: • prevention – through whole body and target specific exercise BLOCKINand BLOCKINeducation BLOCKINprograms • acute BLOCKINand BLOCKINpostacute BLOCKINcare BLOCKIN– BLOCKINpostoperative cardiopulmonary BLOCKINintervention; BLOCKINreturn BLOCKINto BLOCKINphysical function BLOCKINpostsurgery BLOCKINthrough BLOCKINtargeted BLOCKINlarge BLOCKINmuscle mass BLOCKINexercise BLOCKINprograms; BLOCKINspecific BLOCKINmanagement for BLOCKINrecovery BLOCKINof BLOCKINmusculoskeletal BLOCKINand BLOCKINneuromotor function BLOCKIN(eg. BLOCKINfollowing BLOCKINmastectomy); BLOCKINbiopsychosocial approaches BLOCKINto BLOCKINpain BLOCKINmanagement • acute institutional and community based rehabilitation – through simple measures (eg. wheelchair retraining after BLOCKINspinal BLOCKINcord BLOCKINcompression, BLOCKINgait BLOCKINre-training BLOCKINfollowing neurological BLOCKINdysfunction), BLOCKINand • palliative BLOCKINcare BLOCKIN– BLOCKINby BLOCKINutilising BLOCKINall BLOCKINof BLOCKINthe BLOCKINabove BLOCKINapplications and including other physiotherapy specific skills in symptom control management (eg. BLOCKINTENS for pain relief, lymphoedema and incontinence programs, laser therapy for wound and ulcer management, and maintenance of mobility and physical function to optimise quality of life and contribute positively to easing BLOCKINcarer BLOCKINburden). The impact of physiotherapy intervention on quality of life and function was measured in a study comparing standardised inpatient physiotherapy practice (limited by time and equipment resources) with a well resourced physiotherapy service. 3 The results indicated that physiotherapy, incorporating early intervention and community follow up, can contribute significantly to the maintenance of functional independence and quality of life among BLOCKINpatients BLOCKINreceiving BLOCKINpalliative BLOCKINcare. Specifically, physiotherapy contributed to significantly higher BLOCKINfunctional BLOCKINlevels BLOCKINon BLOCKINmid-survival BLOCKINfollow BLOCKINup; BLOCKINimproved maintenance BLOCKINof BLOCKINfunctional BLOCKINindependence, BLOCKINpatient BLOCKINsatisfaction and quality of life; and reduced demand for costly formal inpatient BLOCKINcare BLOCKINas BLOCKINpatients BLOCKINwere BLOCKINsignificantly BLOCKINmore …