1. Role of physiotherapy in the rehabilitation of palliative care patients
Caroline Belchamber Senior Oncology Physiotherapist
Catherine Everett Senior Macmillan Physiotherapist
August 2006

2. Aims
To be aware of the concept of rehabilitation in palliative care and the NICE guidelines on supportive and palliative care
To understand the role of palliative care physiotherapists
To be aware of the physiotherapy service for palliative care patients at Poole Hospital

3. NICE Guidelines
The rehabilitation needs for patients should be assessed at key points in the patient pathway
Cancer rehabilitation attempts to maximise patients ability to function, to promote their independence and to help them to adapt to their condition

4. Rehabilitation
‘To minimise some of the effects which the disease, or it’s treatment has on them. It is often possible to improve the quality of life regardless of their prognosis by helping them to achieve their maximum potential of functional ability and independence or gain relief from distressing symptoms’
ACPOPC 1993

5. The role of the physiotherapist in palliative care
Physiotherapists work with respiratory, neurological, lymphatic, orthopaedic, musculoskeletal, pain and haemotalogical conditions
Education and training of MDT as well as patients and carers
Dissemination of information to MDT with key role in discharge planning
Communication and collaboration between primary and secondary care

6. Physiotherapy interventions
Positioning – prevention of pressure sores
TENS – pain and nausea control
Respiratory care – Non-pharmacological approach and prevention of retained secretions and oxygen therapy
Neurological rehabilitation – e.g SCC, Brain tumours and peripheral neuropathies
Mobility – Exercise tolerance, maintenance and independence
Passive/active range of movement – prevention of contractures
Individual exercise programmes

7. Poole hospital physiotherapy palliative care service
In-patient palliative care service
Two wards with 41 beds
On average 30 patients requiring physio a week
0.6 FTE Oncology physiotherapist since May 2003
FTE Macmillan physiotherapist since June 2005
Expanding palliative care physiotherapy service
Rehabilitation slots introduced in August 2005

8. Case Study 61 year old male SCC
Presented with decreased mobility with pain in right shoulder
PMH – Ca prostate
MRI – 24th Feb cord compression at T2 with extensive disease to T1, T2 and L3
Physiotherapy assessment
Physiotherapy management

9. Conclusion
AHP and their role needs to be recognised in this specialist area of rehabilitation
AHP give ‘control’ back to palliative care patients
AHP increase palliative care patients QOL
Rehabilitation commences from time of diagnosis through the whole cancer trajectory

10. ‘With in the context of palliative care, realistic joint goal setting gives the patient a measure of control, often at a time when they are experiencing helplessness and loss of independence’
Robinson 2000

11. References
NICE guidelines: Supportive and palliative care: Chapter 10: DOH 2004
Jollife, J and Bury (2000). The effectiveness of physiotherapy in palliative care of older people, CSP.
Role of physiotherapy in palliative care ACPOPC 2003