Physio findings: Palliative care and musculoskeletal research

Palliative care

Techniques provide a breath of relief

An innovative support service can help terminally ill patients who are struggling to breathe, a study in the Lancet reports. Patients carrying out the self-management plan not only gained control over their breathing – relieving their distressing symptoms – but also survived longer.

Irene Higginson, from Cicely Saunders Institute at King’s College London, and colleagues devised a breathlessness support service combining physiotherapy, palliative care, respiratory medicine and occupational therapy.

The team then recruited 105 patients with a range of chronic diseases, who had persistent breathlessness although their underlying condition was being controlled
as well as possible.

All continued to receive usual care. But one group also had an outpatient appointment with respiratory or palliative-care clinicians and a home assessment by a physiotherapist or occupational therapist.

This intervention group was given exercises and a breathlessness pack including guidance on pacing, a ‘breathlessness poem’ encouraging them to breathe out fully, and simple devices to help bring their respiration under control.

The intensity of breathlessness is hard to measure objectively, say the researchers, and patients may only have occasional bouts. Instead, the team measured patients’ mastery of their breathlessness – whether they felt more in control of their breathing by the end of the trial. 

‘The amount of perceived breathlessness mastery is probably a more important component of quality of life than is amount of breathlessness,’ the authors note.

After six weeks, the intervention group were found to have significantly better mastery of their breathing than the control group.

There had been no adverse effects, and care of each group had cost about the same.

After six months, more of the intervention group were still alive.

• Higginson IJ et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial, Lancet Respiratory Medicine 2014; http://dx.doi.org/10.1016/S2213-2600(14)70226-7

Musculoskeletal

Physio first for best results

Having physiotherapy before a joint replacement operation could significantly reduce patients’ need for care afterwards, researchers have found.

Physiotherapy is a normal part of rehabilitation after a hip or knee replacement. But researchers in Columbus, Ohio, asked how helpful it would be in preparing for surgery.

The team trawled through records of 4,733 operations to check the outcomes. To ensure it was a fair comparison, they took account of factors such as patients’ other illnesses and differences in how the arthroplasty was carried out.

They found that just 54.2 per cent of patients who had pre-operative physiotherapy needed treatment after the immediate recovery period, compared with 79.7 per cent of those who hadn’t.

‘The use of preoperative physical therapy was associated with a 29 per cent decrease in the use of any post-acute care services,’ they report.

Providing physiotherapy in advance was also less expensive than all the extra nursing and rehabilitation needed afterwards.The team recommend pre-operative physiotherapy ‘to achieve an integrative, cost-effective patient care pathway’.

• Snow R et al. Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement
• Acute Care Utilization Patterns and Cost in Total Joint Replacement, Journal of Bone and Joint Surgery 2014; http://dx.doi.org/10.2106/JBJS.M.01285

Comments and conclusions

Mobility assistance dogs proved their worth in a trial measuring the effort they save their owners. Thirteen spinal-injury patients propelled their manual wheelchairs across tiled and carpeted floors, both alone and with their dogs providing extra traction.

Researchers found the canine helpers significantly reduced the amount of force owners had to apply to the hand rims, especially over carpet. Provision of assistance dogs is ‘a therapeutic alternative that minimizes upper limb risk exposure and optimizes functional capacity’, say the authors.

• Gagnon DH et al. Archives of Physical Medicine and Rehabilitation 2014; http://dx.doi.org/10.1016/j.apmr.2014.07.257

Decisions about patients’ suitability for surgery should be based on their health rather than their age, say the Royal College of Surgeons and the charity Age UK. Researchers found wide variations across the UK in the number of over-65s who received operations that could relieve pain, restore mobility or save lives.

• www.rcseng.ac.uk/news/docs/access-all-ages-2

A well-written physiotherapy case history can be used in the development of clinical guidelines. A new paper aims to help physios create high-quality case reports for the peer-reviewed literature, on the basis of the World Health Organization’s international classification of functioning disability and health model.

• Davenport TE Physiotherapy Research International; http://dx.doi.org/10.1002/pri.1562

Young people living a sedentary life tend to eat unhealthily, a review of 27 studies has found, confirming results of a similar review in 2011.

• Hobbs M et al. British Journal of Sports Medicine 2014; http://dx.doi.org/10.1136/bjsports-2014-093754