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Mohammed J, Kabir R, Bakhsh HR, Greenfield D, Georgievna VA, Bulińska A, Rai J, Gonzales A, Hashmi SK. Should healthcare organisations offer ongoing rehabilitation services for patients undergoing haematopoietic cell transplant? A narrative review. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-05-2020-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PurposeHematopoietic stem cell transplant (HSCT) patients can suffer from long-term transplant-related complications that affect their quality of life and daily activities. This study, a narrative review, aims to report the impact of HCT complications, the benefits of rehabilitation intervention, the need for long-term care and highlights the research gap in clinical trials involving rehabilitation.Design/methodology/approachA comprehensive search strategy was performed on several databases to look for relevant articles published from 1998 to 2018. Articles published in English with the following terms were used: hematopoietic stem cell transplant, chronic graft-versus-host disease, rehabilitation, exercise, physical therapy, occupational therapy. A patient/population, intervention, comparison, and outcomes (PICO) framework was employed to ensure that the search strategies were structured and precise. Study year, design, outcome, intervention, sample demographics, setting and study results were extracted.FindingsOf the 1,411 records identified, 51 studies underwent title/abstract screening for appropriateness, 30 were reviewed in full, and 19 studies were included in the review. The review found that, for the majority of patients who underwent HSCT and developed treatment-related complications, rehabilitation exercises had a positive impact on their overall quality of life. However, exercise prescription in this patient group has not always reflected the scientific approach; there is a lack of high-quality clinical trials in general. The review also highlights the need to educate healthcare policymakers and insurance companies responsible for rationing services to recognise the importance of offering long-term follow-up care for this patient group, including rehabilitation services.Practical implicationsA large number of HSCT patients require long-term follow-up from a multidisciplinary team, including rehabilitation specialists. It is important for healthcare policymakers and insurance companies to recognise this need and take the necessary steps to ensure that HSCT patients receive adequate long-term care. This paper also highlights the urgent need for high-quality rehabilitation trials to demonstrate the feasibility and importance of rehabilitation teams.Originality/valueHealthcare policymakers and insurance companies need to recognise that transplant patients need ongoing physiotherapy for early identification of any functional impairments and appropriate timely intervention.
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Armenian SH, Xiao M, Berano Teh J, Lee B, Chang HA, Mascarenhas K, Lee S, Iukuridze A, Xie JJ, Scott JM, Jones LW, Lennie Wong F, Forman SJ, Nakamura R. Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation. J Natl Cancer Inst 2020; 111:837-844. [PMID: 30951603 DOI: 10.1093/jnci/djy231] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/09/2018] [Accepted: 12/20/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT. METHODS This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided. RESULTS Median age at HCT was 51 years (range = 18-74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001). CONCLUSIONS Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.
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Affiliation(s)
- Saro H Armenian
- See the Notes section for the full list of authors' affiliations
| | - Meisi Xiao
- See the Notes section for the full list of authors' affiliations
| | | | - Brandyn Lee
- See the Notes section for the full list of authors' affiliations
| | - Howard A Chang
- See the Notes section for the full list of authors' affiliations
| | | | - Sean Lee
- See the Notes section for the full list of authors' affiliations
| | - Alex Iukuridze
- See the Notes section for the full list of authors' affiliations
| | - Jack J Xie
- See the Notes section for the full list of authors' affiliations
| | - Jessica M Scott
- See the Notes section for the full list of authors' affiliations
| | - Lee W Jones
- See the Notes section for the full list of authors' affiliations
| | - F Lennie Wong
- See the Notes section for the full list of authors' affiliations
| | - Stephen J Forman
- See the Notes section for the full list of authors' affiliations
| | - Ryotaro Nakamura
- See the Notes section for the full list of authors' affiliations
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Mohammed J, Aljurf M, Althumayri A, Almansour M, Alghamdi A, Hamidieh AA, ElHaddad A, Othman TB, Bazarbachi A, Almohareb F, Alzahrani M, Alkindi SS, Alsharif F, Da'na W, Alhashmi H, Bekadja MA, Al-Shammari SH, El Quessar A, Satti TM, Aljohani N, Rasheed W, Ghavamzadeh A, Chaudhri N, Hashmi SK. Physical therapy pathway and protocol for patients undergoing hematopoietic stem cell transplantation: Recommendations from The Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group. Hematol Oncol Stem Cell Ther 2019; 12:127-132. [PMID: 30653940 DOI: 10.1016/j.hemonc.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients undergoing hematopoietic stem cell transplantation (HSCT) are often referred for physical therapy (PT) to help improve their quality of life. However, to our knowledge there is no clear PT pathway to guide therapists and patients before, during, and after HSCT. METHODS A comprehensive literature review was carried out exploring the role and benefits of PT in HSCT patients. The current evidence was comlimented with recommendations and opinions from the experts in the field, which included PT's and hematology consultants from PTAGVHD and the EMBMT group. RESULT A clear pathway and protocol as a working guide for rehabilitation professionals working with the HSCT patient's was developed. CONCLUSION This paper not only reviews the current evidence on safe PT practice but also puts forward a protocol and pathway for HSCT rehabilitation, highlights the importance of individualized exercise intervention for HSCT patients, and outlines safe practice guidelines for the physical therapists working in this field.
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Affiliation(s)
- Jaleel Mohammed
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK.
| | - Mahmoud Aljurf
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK
| | - Abdulaziz Althumayri
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muntaha Almansour
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Alghamdi
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amir Ali Hamidieh
- Stem Cell Transplantation, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Alaa ElHaddad
- Oncology, National Cancer Institute, Cairo University, Giza, Egypt
| | - Tarek Ben Othman
- Hematology, Centre National De Greffe De La Moelle Osseuse, Tunis, Tunisia
| | - Ali Bazarbachi
- Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fahad Almohareb
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Hepatology & Hematology, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Salam S Alkindi
- Hematology, Sultan Qaboos University Hospital, Al-Khoud, Oman
| | - Fahad Alsharif
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Waleed Da'na
- Implantalogy/Hematology, King Hussein Cancer Center, Amman, Jordan
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohamed A Bekadja
- Department of Hematology and Cell Therapy, University Hospital EHU 1er November, Oran, Algeria
| | | | - Asma El Quessar
- Hematology and Oncology Pediatric Department, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Tariq M Satti
- Bone Marrow Transplant, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Naif Aljohani
- Adult Bone Marrow Transplant, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Walid Rasheed
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ardeshir Ghavamzadeh
- Stem Cell Transplantation, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Naeem Chaudhri
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK; Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
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