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
