Role of physiotherapy in the

rehabilitation of palliative care

patients

Caroline Belchamber Senior Oncology Physiotherapist

Catherine Everett Senior Macmillan Physiotherapist
August 2006
 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
 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
 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
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
 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
 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
 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
 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
‘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
 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