Physiotherapy in Palliative Care

WHAT PALLIATIVE CARE DOES.• Affirms life and regards

dying as a normal process.• Neither hastens or

postpones death.• Provides relief from pain and

other symptoms.• Integrates the psychological

and spiritual aspects of patient care.

• Offers a support system to help patients live as actively as possible until death.

• Offers a support system to help the family cope during the patient’s illness and in their bereavement

ROLE OF A.H.P.’S

• Therapists adopt a patient centred approach while working as part of the multidisciplinary team.

• Patients with palliative care needs represent complex and challenging health care problems. AHP interventions aim to improve mobility, nutritional status, communication and restore confidence in every day living.

• AHP’s assess each individual to establish where they are within the disease process, ascertain the patient’s understanding of this and how this relates to their personal situation.

• AHP’s subsequently tailor interventions according to each individuals situation, stage of illness and wishes by setting achievable treatment goals that foster hope, independence, control and quality of life.

• Physiotherapy is concerned with the care management and rehabilitation of patients from diagnosis to the end of life.

• Palliative care physiotherapy differs from conventional rehabilitation by virtue of the certain knowledge that all patients will decline during the period of care.

• The time and course of the decline can vary considerably; some patients grow progressively weaker, some remain on a plateau for weeks or months and then decline suddenly, some remain active until death.

CONDITIONS SEEN IN PALLIATIVE CARE• Cancer• End stage cardiac

disease• End stage

pulmonary disease• End stage renal

disease

• MND• Progressive

cerebellar atrophy• MS

AIMS OF PHYSIOTHERAPY

• Maintain optimum respiratory function

• Maintain optimum circulatory function

• Prevent muscle atrophy• Prevent muscle

shortening

• Prevent joint contractures

• Influence pain control• Optimise independence

& function• Increase confidence• Educate carers

Fostering a Different Image.

• A common image of physiotherapists is that of someone who pushes people in to doing things they don’t want to. Patients may have this perception and the therapist needs to work to create an image that, through encouragement and enabling, will achieve highly beneficial results.

• Patients may have unrealistic expectations about what physiotherapy can do for them.

• Therapists can spend a considerable amount of time relating closely to patients & may be drawn into situations involving difficult questions. Therapists need good communication skills and may train in counselling skills. Clinical reasoning should be modified by the patient’s goals, be realistic & identified by the patient, coupled with a calculated professional input from the therapist.

• Rehabilitation has been described as the restoration of a patient to a person.

• Palliative care rehabilitation at its best is the transformation of the dying into the living.

Oxford Text of Palliative Medicine.