Rehabilitation in end-of-life management.
OBJECTIVE
Loss of ability to manage daily activities is source of significant distress for palliative patients. In the context of end-of-life care, rehabilitation contributes to patients' sense of autonomy, self-worth, and social participation. The present article provides an overview of recent advances in rehabilitation in end-of-life management, drawing on papers published during 2009.


RESULTS
Palliative patients have rehabilitation needs including difficulties with activities of daily living, disruption to usual routines and roles, and anxieties about being a burden to others. These needs are not adequately identified, leading to patients receiving less than optimal help in living with disability. Research shows that rehabilitation interventions such as exercise programmes have beneficial effects on fatigue and quality of life. In delivering rehabilitation, staff attitudes are important and should support patients' views of themselves as worthwhile, resourceful individuals.


CONCLUSIONS
Adequate screening procedures are necessary to identify functional difficulties so that appropriate help might be provided. There is now a growing body of work on the therapeutic benefits of exercise. There is a need for further experimental studies with larger samples to demonstrate effectiveness of interventions, as well as for qualitative studies examining the mechanisms of rehabilitation.
Eva
Gail
G
Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK. gail.eva@ndm.ox.ac.uk
Wee
Bee
B
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D005081:Exercise Therapy; D005221:Fatigue; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D009369:Neoplasms / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy; D010166:Palliative Care; D010342:Patient Acceptance of Health Care; D010358:Patient Participation / Q000523:psychology*; D026684:Personal Autonomy; D011788:Quality of Life / Q000523:psychology; D012649:Self Concept; D012938:Social Perception; D013315:Stress, Psychological