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Nishiyama N, Matsuda Y, Fujiwara N, Ariyoshi K, Oyamada S, Narita K, Ishii R, Iwase S. The efficacy of specialised rehabilitation using the Op-reha Guide for cancer patients in palliative care units: protocol of a multicentre, randomised controlled trial (JORTC-RHB02). BMC Palliat Care 2020; 19:164. [PMID: 33092573 PMCID: PMC7579867 DOI: 10.1186/s12904-020-00670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although rehabilitation is recommended for terminal cancer patients, the specific components and methods of such programs are poorly documented. No studies to date have examined the effectiveness of rehabilitation for terminal cancer patients. This study aims to evaluate the efficacy of a new intervention for rehabilitation therapists, using the Op-reha Guide (Guide to Optimal and Patient-Centred Rehabilitation Practice for Patients in Palliative Care Units [PCUs]) in rehabilitation practice. This guide consists of recommended actions and attitudes for rehabilitation therapists and aims to optimise therapists' actions according to the patient's needs and condition. It shares goals with terminal cancer patients to maintain their activities of daily living (ADL). METHODS This study uses a multicentre, prospective, randomised controlled trial (RCT) design with two parallel groups in PCUs where specialised rehabilitation will be routinely performed for terminal cancer patients by rehabilitation therapists. Participants will be randomised (1:1) to intervention (the Op-reha Guide) and control groups (usual rehabilitation). We will then conduct an observational study in PCUs that do not perform specialised rehabilitation for terminal cancer patients; this will be considered the usual care group, and the efficacy of usual rehabilitation will be quantitatively evaluated. Inclusion criteria are hospitalisation in PCU, European Cooperative Oncology Group Performance Status of 2 or 3, and clinical estimation of life expectancy of 3 weeks or more. Patients with severe symptom burden will be excluded. We hypothesise that the Op-reha Guide will be more effective in maintaining the ADL of terminal cancer patients hospitalised in PCUs than usual rehabilitation. The primary endpoint is defined as the change in (total) modified Barthel Index from baseline to Day 22. Quality of life will be a secondary endpoint. In total, 135 patients will be recruited from 16 Japanese sites between July 2019 and December 2021. DISCUSSION This will be the first trial to evaluate the efficacy of specialised rehabilitation for terminal cancer patients hospitalised in PCUs, and will contribute to the evidence on the efficacy of implementing rehabilitation for terminal cancer patients. TRIAL REGISTRATION UMIN-CTR, UMIN000037298 R000042525 (date of registration 7 July 2019).
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Affiliation(s)
- Nanako Nishiyama
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30, Habikino, Habikino-city, Osaka, 583-8555, Japan.
- Department of Clinical Research, NPO JORTC, Tokyo, Japan.
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Centre, Sakai, Japan
| | - Noriko Fujiwara
- IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | | | | | - Keiichi Narita
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryouhei Ishii
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30, Habikino, Habikino-city, Osaka, 583-8555, Japan
| | - Satoru Iwase
- Department of Emergency & Palliative Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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Nguyen TTH, Nguyen TX, Pham T, Nguyen CT, Thu Vu G, Nguyen LH, Tran BX, Vu HTT, Latkin CA, Ho CS, Ho RC. Establishing activity centers for elderly people in metropolitan areas of Vietnam: preference and willingness-to-pay. J Multidiscip Healthc 2019; 12:795-802. [PMID: 31571897 PMCID: PMC6755241 DOI: 10.2147/jmdh.s193821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose and aim The activity center (AC), an effective model for health support and health-related quality of life improvements for older people, has been operating for many years worldwide. This study aimed to assess the necessity of and preference for attending AC and its desired functions and facilities in elderly people in Vietnam. Subjects and methods A cross-sectional study was conducted at parks and senior clubs, with 121 participants from 6 February to 20 April 2017, in Hanoi. The health status, preference, and willingness-to-pay for AC use of respondents were assessed. Results Over 75% of respondents agreed to establish an AC for older people. Among them, approximately 71.7% were willing to pay a monthly fee for this center. Elderly individuals who obtain regular physical examination when feeling pain/discomfort and who were participating in clubs for elder people were more likely to agree to establish and pay for an AC. Meanwhile, women who have to take care of grandchildren, people who were saving money and people who had children working in organizations or who were freelancers were less likely to agree to establish and pay for AC. Conclusion The results suggest the feasibility of establishment of ACs in Vietnam, with a high proportion of participants agreeing to such establishing and willing to pay for the AC.
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Affiliation(s)
- Thu Thi Hoai Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam.,Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam.,Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam
| | - Thanh Xuan Nguyen
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam.,Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam
| | - Thang Pham
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam.,Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Huyen Thi Thanh Vu
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam.,Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger Cm Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Maddocks M, Reilly CC, Jolley C, Higginson IJ. What Next in Refractory Breathlessness? Breathlessness? Research Questions for Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971403000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Matthew Maddocks
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK
| | - Charles C. Reilly
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Caroline Jolley
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J. Higginson
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Booth S, Chin C, Spathis A, Maddocks M, Yorke J, Burkin J, Moffat C, Farquhar M, Bausewein C. Non-pharmacological interventions for breathlessness in people with cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1524708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Booth
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | - Chloe Chin
- Consultant in Palliative Medicine, Camden, Islington, ELiPSE and UCLH & HCA
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie Burkin
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Germany
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Lee CH, Kim JK, Jun HJ, Lee DJ, Namkoong W, Oh JH. Rehabilitation of Advanced Cancer Patients in Palliative Care Unit. Ann Rehabil Med 2018; 42:166-174. [PMID: 29560337 PMCID: PMC5852220 DOI: 10.5535/arm.2018.42.1.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. Methods Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. Results Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p<0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p<0.05). Conclusion Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.
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Affiliation(s)
- Chang Hyun Lee
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Jong Kyu Kim
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Hyun Jung Jun
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Duk-Joo Lee
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Wook Namkoong
- Department of Family Medicine, Seoul Medical Center, Seoul, Korea
| | - Jae Ho Oh
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
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Olsson Möller U, Stigmar K, Beck I, Malmström M, Rasmussen BH. Bridging gaps in everyday life - a free-listing approach to explore the variety of activities performed by physiotherapists in specialized palliative care. BMC Palliat Care 2018; 17:20. [PMID: 29378566 PMCID: PMC5789614 DOI: 10.1186/s12904-018-0272-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A growing body of studies indicate benefits of physiotherapy for patients in palliative care, for symptom relief and wellbeing. Though physiotherapists are increasingly acknowledged as important members of palliative care teams, they are still an underutilized source and not fully recognized. The aim of this study was to explore the variety of activities described by physiotherapists in addressing the needs and problems of patients and their families in specialized palliative care settings. METHODS Using a free-listing approach, ten physiotherapists working in eight specialized palliative care settings in Sweden described as precisely and in as much detail as possible different activities in which patients and their families were included (directly or indirectly) during 10 days. The statements were entered into NVivo and analysed using qualitative content analysis. Statements containing more than one activity were categorized per activity. RESULTS In total, 264 statements, containing 504 varied activities, were coded into seven categories: Counteracting a declining physical function; Informing, guiding and educating; Observing, assessing and evaluating; Attending to signs and symptoms; Listening, talking with and understanding; Caring for basic needs; and Organizing, planning and coordinating. In practice, however, the activities were intrinsically interwoven. The activities showed how physiotherapists aimed, through care for the body, to address patients' physical, psychological, social and existential needs, counteracting the decline in a patient's physical function and wellbeing. The activities also revealed a great variation, in relation not only to what they did, but also to their holistic and inseparable nature with regard to why, how, when, where, with whom and for whom the activities were carried out, which points towards a well-adopted person-centred palliative care approach. CONCLUSIONS The study provides hands-on descriptions of how person-centred palliative care is integrated in physiotherapists' everyday activities. Physiotherapists in specialized palliative care help patients and families to bridge the gap between their real and ideal everyday life with the aim to maximize security, autonomy and wellbeing. The concrete examples included can be used in understanding the contribution of physiotherapists to the palliative care team and inform future research interventions and outcomes.
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Affiliation(s)
- U Olsson Möller
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - K Stigmar
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - I Beck
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Faculty of Health Science, The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
| | - M Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - B H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Abstract
PURPOSE OF REVIEW Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. RECENT FINDINGS Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. SUMMARY We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.
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Schuler MK, Hentschel L, Kisel W, Kramer M, Lenz F, Hornemann B, Hoffmann J, Richter S, Ehninger G, Bornhäuser M, Kroschinsky F. Impact of Different Exercise Programs on Severe Fatigue in Patients Undergoing Anticancer Treatment-A Randomized Controlled Trial. J Pain Symptom Manage 2017; 53:57-66. [PMID: 27744016 DOI: 10.1016/j.jpainsymman.2016.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022]
Abstract
CONTEXT Physical exercise can alleviate cancer-related fatigue. Randomized controlled trials in patients with advanced cancer are scarce. OBJECTIVES We test the impact of a structured, individual sports program on fatigue in patients with advanced cancer. METHODS Seventy-seven patients were invited to participate in this randomized controlled trial exploring the effects of physical exercises on fatigue 12 and 24 weeks after baseline. Patients were randomized into three groups. Group A received treatment as usual, Group B was taught a structured, individual sports program, and Group C received additional ambulatory physiotherapeutical supervision. Primary outcome was general fatigue, secondary outcomes included rate of severe general fatigue, further dimensions of the Multidimensional Fatigue Inventory (MFI), as well as walking distance. RESULTS Mean score of general fatigue as well as other MFI subdimensions differed nonsignificantly between all groups at 12 weeks. However, the mental fatigue score demonstrated a statistically significant difference between the three groups. The rate of severe general fatigue was significantly reduced within Intervention Group C. Significant longitudinal change of MFI-dimension mental fatigue was found and reached the threshold for minimal clinically important difference, while all MFI-dimensions increased in Group A. CONCLUSION Our results imply that tumor-patients' severe general fatigue can be reduced when patients conduct appropriate physical exercise. This study amends previous knowledge, as it describes the impact of outpatient physical exercise on fatigue in a heterogeneous patient cohort with various advanced cancer entities. Furthermore, this trial differentiates between patients with only a self-directed exercise program versus those receiving additional partially professional supervision.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Clinic for Internal Medicine II, HELIOS Hospital Emil von Behring, Berlin, Germany
| | - Leopold Hentschel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Wadim Kisel
- Department of Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felicitas Lenz
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Beate Hornemann
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julia Hoffmann
- University Physiotherapy Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Malcolm L, Mein G, Jones A, Talbot-Rice H, Maddocks M, Bristowe K. Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliat Care 2016; 15:97. [PMID: 27964735 PMCID: PMC5155388 DOI: 10.1186/s12904-016-0173-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/03/2016] [Indexed: 12/11/2022] Open
Abstract
Background Exercise is increasingly recognized as a core component of palliative rehabilitation. The group exercise model is often adopted as a means of reaching more patients with limited resource. Despite the growth of quantitative research examining this area of practice, few qualitative studies have looked at the patient experience of participating in group exercise in a palliative setting, and most exclude patients with a non-cancer diagnosis. Methods The aim of this study was to explore patients’ experiences of participating in group exercise classes in a hospice setting. In this qualitative, phenomenological study, nine patients participating in a group exercise programme at a South London hospice completed semi-structured interviews. Participants were purposively sampled by gender, age, ethnicity and diagnosis; to include diagnoses across cancer, respiratory and neurological conditions. Transcripts were interpreted using thematic analysis. Results All patients reported positive experiences of participating in group exercise classes. Improvements reported in physical function had a positive effect on ability to complete activities of daily living and enhanced patient mood. Other reported psychosocial benefits included: promotion of self-management; space and opportunity for reflection; supportive relationships; sharing of information; and a deeper appreciation of patients’ own abilities. Conclusion This study highlights the positive experiences and value of group exercise classes to groups of people with diverse cancer and non-cancer conditions. The physical, emotional and psychosocial benefits suggest hospices and other palliative services should explore similar programmes as part of their rehabilitation services. The recognition that exercise groups can be mixed and need not be bespoke to one condition has positive cost and staff resource ramifications.
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Affiliation(s)
- Lorna Malcolm
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK.
| | - Gill Mein
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, Cranmer Terrace, London, SW17 0RE, UK
| | - Alison Jones
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Helena Talbot-Rice
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, UK
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Brown D, Claffey A, Harding R. Evaluation of a physiotherapy-led group rehabilitation intervention for adults living with HIV: referrals, adherence and outcomes. AIDS Care 2016; 28:1495-1505. [PMID: 27264319 DOI: 10.1080/09540121.2016.1191611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
HIV is characterised by episodes of disability. We report a novel, hospital outpatient rehabilitation intervention, combining physiotherapy-led group exercise and education for people living with HIV (PLWH). This observational study evaluated routine delivery of the 10-week intervention in terms of referral patterns, rehabilitation goals, intervention adherence and change in patient outcomes. Measurements at baseline & 10 weeks included locomotor performance (6 minute walk test; 6MWT), flexibility, upper and lower limb strength and health related quality of life (HRQOL). Adherence was defined as attending ≥8/20 sessions, with reasons for non-adherence identified in retrospective telephone interviews. Goal Attainment Scale measured progression to individual goals. Total 92 referrals were mostly for musculoskeletal (25.0%), oncological (19.6%) or cardio-metabolic (18.5%) reasons, and mostly male (81.5%), Caucasian (70.7%) and older (mean 51.5 years). Common themed rehabilitation goals included improving body image, participation, mobility, health/fitness and function. Adherence was achieved by 42 (46%) patients, with open access utilised by 34 patients, returning (n = 19) or restarting when non-adherent (n = 15). Post-intervention measurements collected for 37 (40%) patients demonstrated improvements in 6MWT distance (p < .001), flexibility (p < .001), strength in triceps (p < .001), biceps (p < .001), Lattisimus Dorsi (p < .001), shoulder-press (p < .001), chest-press (p < 0.001), and leg-press (p < 0.001). HRQOL improved in total score (p < .001), physical (p < .001), emotional (p < .001) and functional (p = .065) subscales. Extent of goal achievement demonstrated 83% of goals was "expected" (n = 57), "somewhat more" (n = 31) or "much more" (n = 14). Reasons for non-adherence from 21 telephone interviews identified physical health challenges, individual factors and time or location issues. This novel rehabilitation approach for PLWH improved function, HRQOL and goal attainment among those completing the intervention. Sub-optimal adherence likely relates to episodic disability.
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Affiliation(s)
- Darren Brown
- a Therapies Department , Chelsea and Westminster Hospital , London , UK
| | - Austin Claffey
- b School of Health & Social Care, London South Bank University , London , UK
| | - Richard Harding
- c Department of Palliative Care, Policy & Rehabilitation , King's College London, Cicely Saunders Institute , London , UK
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Turner K, Tookman A, Bristowe K, Maddocks M. 'I am actually doing something to keep well. That feels really good': Experiences of exercise within hospice care. PROGRESS IN PALLIATIVE CARE 2016; 24:204-212. [PMID: 27453639 PMCID: PMC4940895 DOI: 10.1080/09699260.2015.1123441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation. Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life. Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life.
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Affiliation(s)
- Karen Turner
- Royal Free London NHS Foundation Trust, London, UK; Marie Curie Hospice Hampstead, UK
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