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  • Systematic Review: Physical Therapy in Hospice and Palliative Settings Supported by Limited Research

    A review of recent research on the role of physical therapy in hospice and palliative care supports the idea that physical therapy can go a long way toward improving patients' physical, social, and emotional well-being. The problem, according to authors, is that the research itself has a long way to go.

    In a systematic review published in the American Journal of Hospice & Palliative Medicine (abstract only available for free), authors reviewed 13 articles—mainly qualitative—that looked at the use of physical therapy among patients diagnosed with a critical or terminal illness. Authors focused on 5 major components addressed in the various studies—age of participants, types of physical therapy interventions used, assessment tools used, efficacy of treatment, and patient-reported satisfaction and quality of life. Authors of the study include Ahmed Radwan, PT, DPT, PhD.

    Age. Participants ranged in age from 17 to 95. Most subjects were 40-70 years old.

    Interventions. The most frequently discussed interventions were strengthening/therapeutic exercises, patient and family/caregiver education, balance and falls training, and transfer training.

    Assessment tools and outcome measures. Though a variety of outcome measures were used, the most common tools used in the studies were ones that rated patients' pain levels—mostly numeric scales; however, no single tool or measure was used in more than 1 study.

    Efficacy of treatment. "Throughout all of the 13 reviewed articles, it was reported that physical therapy resulted in improvements in a variety of aspects of patients' function and symptoms," authors write. Not surprisingly, most of the improvements were related to pain, although some studies noted improvements in mobility, activities of daily living, endurance, mood, fatigue, and lymphedema.

    Patient satisfaction. Among the studies reviewed, only 5 directly addressed satisfaction or quality of life. All found that these factors had improved.

    While the findings are encouraging, authors of the review also include a long list of limitations to their analysis, most having to do with the current dearth of information on the role of physical therapy in hospice and palliative care.

    Primary among the limitations is what authors believe is a general lack of quantitative research on the topic. When it comes to the reviewed studies themselves, authors cited limitations that include a lack of specificity around the types of treatment provided; multidisciplinary care approaches that, though "realistic," made it difficult to precisely identify the impact of physical therapy; a lack of discussion of treatment costs; high dropout rates; and the fact that every study used a different outcome measure.

    Despite those problems, authors believe that their review sheds some light on how physical therapy is used in hospice and palliative care, and the ways in which it can improve quality of life for patients and caregivers.

    "It is apparent that there is benefit in utilizing physical therapy in end-of-life and palliative care settings," authors write. "This study confirms that physical therapists serve a vital role in [these] settings and should be active members of the multidisciplinary team providing care for this critical patient population."

    APTA advocates for the use of physical therapy in hospice and palliative care, and offers a webpage devoted to the topic. Resources include guides, podcasts, and links to information from Medicare and Medicaid. In addition, PTNow's resources include a health care guideline on palliative care.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • I'm presenting at CSM on Thursday specifically on this topic and have incorporated this article into my slides. Join me at CSM!!!

      Posted by Caryn McAllister -> =NWc>M on 1/29/2016 7:30 AM

    • Excellent work. Just another reason that experienced and Doctors of Physical Therapy should be recognized as Primary Care Practitioners for NMS conditions. Will try to make your presentation. Good luck

      Posted by Jerry L. Klug,PT, DPT on 2/3/2016 6:49 PM

    • Caryn, I'm not able to make it to CSM; is there another way to get access to your presentation? Thank you!

      Posted by Beth Strawhun on 2/3/2016 10:00 PM

    • As an athlete, I've always believed in good physical therapy. So to see the fact that there's research that supports the idea that it improves multiple aspects of life is something that makes me happy. Palliative care is something that I'm getting more and more interested in as I get a little older. Thanks for the great info.

      Posted by Tobias Armstrong on 3/9/2016 3:59 PM

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