• News New Blog Banner

  • 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.

    Survey: 1 in 20 Children Have Problems with Balance or Dizziness

    In what they describe as the first-ever study among children in the US, authors of an epidemiology review estimate that 3.3 million children—about 1 in 20—suffer from some kind of dizziness or balance problem, with 600,000 experiencing symptoms that result in "moderate" or "very big" problems.

    The results are based on a probability sample of 10,954 children aged 3-17 years, by way of survey responses supplied by parents or caregivers. Respondents answered questions about whether, during the past 12 months, their children were bothered by vertigo, poor balance, poor coordination, frequent falls, light-headedness, or any other kind of dizziness or balance problems. Responses were then cross-referenced with other demographic and health information to create a picture of prevalence and potential risk factors. The full report is published in The Journal of Pediatrics (abstract only available for free).

    Among the findings:

    • Overall prevalence for dizziness and balance problems was 5.3% and increased with age, from 4.1% at 3-5 years to 7.5% for ages 15-17. Girls had a 5.7% prevalence, compared with boys' prevalence of 5.0%.
    • "Poor coordination" was the most often-reported symptom (46%), followed by light-headedness (35.1%), poor balance (30.9%), vertigo (29%), frequent falls (25%), and "other" (8.5%). Children were more likely to have 2 or more symptoms than a single symptom.
    • Among the children with balance and dizziness problems, 32.8% had received a diagnosis, a rate that increased to 59.6% for children with moderate to very big problems. Overall rates for being seen by a health care professional in the past year were 36%, and 71.6% among children who had moderate to very big problems.
    • Identified risk factors include being aged 12-17, household education less than high school, family income below the poverty level, low and very low birth weight, first steps without support at 15 months or later, and various developmental or illness conditions.
    • The most strongly associated risk factors, in order, were problems that limited a child's ability to crawl, walk, run, or play; frequent headaches/migraines; "other" developmental delays; seizures during the past 12 months; stuttering/stammering; hearing difficulty; and anemia during the past 12 months.
    • Low and very low birth weight was "significantly associated" with some, but not all, dizziness and balance symptoms—specifically, poor balance, poor coordination, and frequent falls, but not with vertigo or light-headedness. "This suggests that birth weight is more strongly associated with motor problems," authors write.
    • Prevalence of dizziness and balance problems among children with difficulty hearing was 20.9%. For children with vision problems (including those addressed by corrective lenses), prevalence was 14.4%.
    • The results are drawn from a survey funded by the National Institute on Deafness and Other Communication Disorders in 2012, and will be used as baseline data in the National Institutes of Health Healthy People 2020 initiative.

    Authors hope that the results will help with what they describe as a "poorly understood" health problem for a significant number of children in the US, and assert that the ways parents responded to the survey shed much light on the work that needs to be done.

    "Among the one-third of children in this study whose parents/caregivers reported they had been given a diagnosis, 49% replied that the dizziness and balance problems were due to 'other' unspecified causes," authors write. "This finding is not surprising. Almost 90% of children with balance disorders are categorized as 'unspecified dizziness,' indicating that the diagnostic accuracy and methods of physicians treating children with balance problems should be improved."

    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.