THE EFFECTS OF PHYSICAL THERAPY ON QUALITY OF LIFE IN ADULT PATIENTS ON HOSPICE OR PALLIATIVE CARE: A SYSTEMATIC REVIEW

Transcription

1 THE EFFECTS OF PHYSICAL THERAPY ON QUALITY OF LIFE IN ADULT PATIENTS ON HOSPICE OR PALLIATIVE CARE: A SYSTEMATIC REVIEW Shannon Gilman, SPT Jane Grenaldo, SPT Dana Principe, SPT Gianna Scarpelli, SPT Dr. Tracey Collins, PT, PhD, MBA, GCS

2 Overview Introduction Purpose Search Terms Limitations PRISMA PEDro Results Conclusion Discussion Clinical Relevance Acknowledgements 2

3 Definitions 1 Quality of life (QOL): the standard of health, comfort and happiness experienced by the individual Hospice Care: a supportive approach to treatment that focuses on quality rather than length of life and intent is to provide humane and compassionate care for people in the last phases of incurable disease so that they may live as comfortably and fully as possible Palliative Care: the active total care of patients whose disease is not responsive to curative treatment with the goal of symptom control and attention to the whole patientpsychologically, socially and spiritually 3

4 Introduction 2 Little research has been conducted regarding maintenance and recovery of physical function Specifically for patients with incurable cancer with limited life expectancy Physical independence and strength and endurance maintenance throughout the course of disease is a desire of patients receiving hospice or palliative care 4

5 Introduction Continued 2,3 Physical activity and nutrition are needed to: Maintain a sense of well-being Enhance QOL Reduce emotional distress Physical therapy during hospice or palliative care is effective to restore physical and psychological function 5

6 Purpose Determine the impact of physical therapy intervention on quality of life in adult patients receiving palliative or hospice care 6

7 Search Terms Physical therapy AND hospice AND palliative AND quality of life Databases searched: PubMed CINAHL ProQuest Health and Medical Complete Science Direct 7

8 Inclusion Criteria Peer-reviewed Published between Scholarly journals Published in English Adults aged >18 Human subjects 8

9 Included Eligibility Screening Identification Records identified through database searching (n=62) PRISMA Records after duplicates removed (n=59) Records screened (n=59) Records excluded based on title (n=24) Records screened for eligibility (n=35) Records excluded, with reasons (n=33) Article is irrelevant (n=1) Does not measure QOL (n=6) Subjects are not under hospice or palliative care (n=7) Did not receive intervention/ treatment from PT (n=19) Records included (n=4) Additional records identified by hand search (n=2) 9

10 PEDro 0 = NO (N) 1 = YES (Y) Author, Year 1* Final Score Buss et. al., 2010 Y N N Y N N N Y N Y N 3/10 Oldervall et. al., 2006 Y N N N N N N Y Y N Y 3/10 Jones et. al., 2012 Y Y Y N N N N Y Y Y Y 6/10 Cobbe et. al., 2012 Y N N Y N N N N Y N Y 3/10 10

11 Results 62 articles were screened for eligibility 4 records met the criteria PEDro scores ranged from 3-6/10 with an average of 3.75 Sample sizes ranged from subjects (294 total) There were 99 subjects who dropped out, 78 of those due to death Treatment parameters varied widely with durations ranging from minutes, 2-3 times/week for 3-12 weeks 11

12 Results Continued PT interventions included: Gait and transfer training, circuit training, stretching, muscle strengthening, standing balance, and aerobic endurance Outcome measures to assess QOL included: Rotterdam Symptom Checklist (RSCL), European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), EuroQol-5 Dimensions (EQ-5D), Edmonton Functional Assessment Tool 2nd Edition (EFAT-2) 12

13 Results Continued None of 4 studies found statistically significant increases in QOL while using PT as an intervention 2 of 4 studies reported that QOL remained stable over the course of PT treatment, and 1 of these 2 studies reported a decline in QOL in the control group 1 study reported an insignificant increase in QOL overall (EQ-5D) with a significant increase in 1 of the 5 dimensions (health state status) 13

14 Conclusion Weak evidence in support of using PT as an intervention to maintain or increase QOL in adults receiving palliative or hospice care 14

15 Limitations Small samples Varied outcome measures Lack of long-term follow up Drop out rate secondary to poor health status or death Selected databases 15

16 Future Research Larger sample sizes are needed to determine the optimal mode and parameters for PT intervention in palliative and hospice care 16

17 Clinical Relevance PT interventions may improve or maintain QOL in patients on hospice or palliative care Health care professionals should be educated on inclusion of PT in a patient s plan of care PTs in these settings should advocate for the importance of individualized treatments based on patient diagnosis and personal goals 17

18 Acknowledgements Thank You Dr. Collins, PT, PhD, MBA, GCS Dr. Hakim, PT, PhD, NCS Dr. Sanko, PT, EdD Bonnie Oldham, MS, MLS, AB University of Scranton Physical Therapy Department 18

19 References 1. Waller A, Caroline NL. Handbook of Palliative Care in Cancer. Newton, MA: Butterworth-Heinemann; Oldervoll LM, Loge JH, Paltiel H, Asp MB, Vidvei U, Wiken AN, Hjermstad MJ, Kaasa S. The effect of a physical exercise program in palliative care: a phase II study. Journal of Pain and Symptom Management. 2006; 31(5) doi: /j.jpainsymman Buss T, de Walden-Galuszko K, Modlinska A, Osowicka M, Lichodziejewska-Niemierko M, Janiszewska J. Kinesitherapy alleviates fatigue in terminal hospice care patients an experimental controlled study. Supportive Care in Cancer. 2010; 18(6): doi: /s Cobbe S, Kennedy N. Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy. Journal of Palliative Medicine. 2012; 15(7): doi: /jpm Jones L, Fitzgerlad G, Leurent B, Round J, Eades J, Davis S, Gishen F, Holman A, Hopkins K, Tookman A. Rehabilitation in advanced, progressive, recurrent cancer: a randomized control trial. Journal of Pain and Symptom Management. 2013; 45(3) doi: /j.painsymman De Haes J, C J M, & Olschewski M. (1998). Quality of life assessment in a cross-cultural context: use of the Rotterdam Symptom Checklist in a multinational randomised trial comparing CMF and Zoladex (Goserlin) treatment in early breast cancer. Annals of Oncology, 9(7), Aaronson N K et. al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. Journal of the national cancer institute, 85(5), Badia X, Schiaffino A, Alonso J, & Herdman M. (1998). Using the EuroQol 5-D in the Catalan general population: feasibility and construct validity. Quality of life research, 7(4), Kaasa T, Wessel J, Darrah J, & Bruera E. (2000). Inter-rater reliability of formally trained and self-trained raters using the Edmonton Functional Assessment Tool. Palliative medicine, 14(6),