The utilization of physical therapy in a palliative care unit.
BACKGROUND
In the supportive oncology and palliative care settings, rehabilitation interventions are often overlooked and underutilized, despite high levels of functional disability in these patients. As a result, little is known about the utilization or effectiveness of rehabilitation interventions in palliative care populations.


OBJECTIVE
To assess the utilization of physical therapy (PT) in a hospital-based palliative care unit, to characterize functional disabilities in patients who received PT, and to identify factors related to functional improvement following a course of PT.


METHODS
Retrospective chart review of 100 patients (mean age 70 years, 97% male) discharged from the Milwaukee Veterans Hospital Palliative Care unit over 15 months. Activities of daily living (ADL) performance scores were recorded on admission, at 2 weeks, and at completion of the PT program and correlated with demographic and disease-related variables.


RESULTS
Thirty-seven patients received a formal PT assessment, and 18 patients underwent PT. The most common functional disabilities in patients who received PT were deconditioning, pain, imbalance, and focal weakness. Ten patients demonstrated improvement in ADL function at 2 weeks. Six patients completed the course of PT. Albumin was significantly correlated with functional improvement. When controlling for albumin, patients with diagnosis of dementia were more likely to show improvement in functional status than patients without a dementia diagnosis.


CONCLUSIONS
PT assessment and utilization were uncommon in this group. When utilized, PT benefited 56% of patients. Factors related to functional improvement following a PT course were a higher albumin level and a diagnosis of dementia. Prospective trials of PT in palliative care patients are needed to better define response rate and predictors of response.
Montagnini
Marcos
M
Division of Geriatrics and Gerontology, Department of Internal Medicine, The Medical College of Wisconsin Milwaukee, Wisconsin, USA. Marcos.Montagnini@med.va.gov
Lodhi
Mohammed
M
Born
Wendi
W
D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities / Q000534:rehabilitation; D004194:Disease / Q000145:classification; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000534:rehabilitation; D010166:Palliative Care / Q000458:organization & administration*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014600:Utilization Review; D014922:Wisconsin