Multidisciplinary approach in palliative care
Palliative care (PC) is an approach to improve the quality of life of patients (adults and children) and their families facing problems related to a life-threatening illness. Palliative care prevents and alleviates suffering of all kinds-physical, psychological, social, and spiritual-experienced by adults and children living with life-limiting health conditions. Suppose the focus is to improve the quality of life of the patient and child. In that case, it must include those professionals who in a multidisciplinary manner will intervene to achieve this goal.
Even in Mexico, the General Health Law establishes that medical care activities must be preventive, curative, rehabilitative, and palliative. Physicians, nurses, social workers, psychologists, physiotherapists, nutritionists, and doctors are among the personnel recommended to integrate a palliative care service.
Importance of physiotherapy in palliative care
Physiotherapy is a service provided to individuals and populations to develop, maintain, and restore functional capacity throughout the life span. Such support is provided in circumstances where movement and function are affected by disease, aging, injury, pain, disorders, conditions, and/or environmental factors, with the understanding that functional movement is fundamental to what it means to be alive and to be healthy. It is a growing field in Latin American countries, with more and more areas of opportunity and need for its intervention in health, and PCs are no exception.
In this area, the physiotherapist performs his or her work by identifying the terminal criteria of oncologic and non-oncologic disease, the degree of evolution of the disease, promoting the interdisciplinary management in the medical team, managing physiotherapeutic techniques according to the patient’s needs to improve his quality of life with a physical therapy approach according to the symptoms identified in the patient. Among the multiple symptoms that a palliative patient presents, they can have a physiotherapeutic intervention with high, medium, and low impact.
Physical rehabilitation in palliative care
Among oncologic diseases that can be treated, pain is one of the most disabling and limiting symptoms, so it is important to assess the aggressiveness of the different treatments and to mitigate the appearance of multiple organic, psychological, and social alterations. There are several techniques to be applied: Acupuncture: it is safe and adverse effects are infrequent, accompanied by pharmacotherapy and physiotherapy can significantly reduce pain; Manual therapy: improves local circulation and excites the free nerve endings, reduces edema, and induces local and general well-being; Ischemic compression: is the application of force on the specific point of pain, which decreases the symptom and increases the range of joint movement. There are various physical rehabilitation techniques that help to treat asthenia or fatigue, lymphedema, sleep disorders and other symptoms such as cachexia or sarcopenia, depending on the underlying disease and the clinical conditions of each patient.
Educational model of physiotherapy in palliative care
Although a cure is not possible in certain patients, it is possible to improve their quality of life through a multidisciplinary approach. Since there was no specific training in physiotherapy in palliative care, in Puebla, Mexico, in 2022 was created a course with the “Diploma of High Specialty in Physiotherapy in Palliative Care”, with internships in two local hospitals, so that students could learn about real scenarios where this care is provided. The students for this diploma have the opportunity to identify the type of illnesses that require PC, recognize the symptoms in patients, familiarize themselves with the treatments and apply these techniques to relieve patients.
Fig. 1 shows a seven-year-old patient with an intracranial tumor, with four years of palliative care approach, where physiotherapy (PT) has allowed her to acquire a better understanding of her condition.
She currently walks now unaided and attends a special care school. This patient underwent flexibility exercises to obtain a wide and optimal movement for her activities, obtaining adequate articular joint ranges and improved elasticity of the viscoelastic elements and muscle extensibility, mainly focused on extremities, for at least 3 times a week at the beginning and at the end of each rehabilitation session.
Palliative treatment (PT) is based on improving proprioception, muscle strength and limiting the impact of the disease. Physiotherapy plays an adjuvant role in palliative treatment, with a variation of activities to improve the patient’s symptoms and body functions. The literature states that there is a shortage in the provision of paediatric PC for children with cancer. In an interview of PC providers-physicians, nurses, and other team members-one-third of respondents commented that insufficient PC training is considered a barrier to early integration of PCs. Hence, educational programes in other areas of health care are needed to increase the care of paediatric patients with palliative needs.
This aricle was published with permission form Notas Paliativas www.paliativossinfronteras.org.
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