Full-body physical therapy evaluation for pre- and post-hematopoietic cell transplant patients and the need for a modified rehabilitation musculoskeletal specific grading system for chronic graft-versus-host disease

Hematopoietic stem cell transplantation (HSCT) patients can suffer from various musculoskeletal problems resulting in long-term functional incapacity. Physical therapy (PT), as a part of the healthcare team, has been historically advocated for regaining functional capacity and improving quality of life post-HSCT. Because of the nature of this condition and the burden of post-transplant complications, this patient group requires a unique approach toward their rehabilitation that takes into account their complex musculoskeletal presentation ranging from fascia, muscle, tendons, bones, and ligaments. However, to our knowledge there is no universal standardized PT protocol or pathway to help guide rehab specialists to achieve optimal gains for this patient group, and anecdotal evidence suggests that these patients do not always receive the PT care they require. Hence, in collaboration with the Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation, the Survivorship Special Interest Group of the American Society of Blood and Marrow Transplantation, and the Quality of Life Committee of the Eastern Mediterranean Blood and Marrow Transplantation, herein the Physical Therapy Association for Graft Versus Host Disease provides a brief review on role of PT in mitigating musculoskeletal complications in HSCT patients and makes evidence-based recommendations for incorporation of PT into routine HSCT care.

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“…2. A full body functional evaluation before transplant may help in early identification of any functional loss [10]. 3.…”

Section: Post-transplantmentioning

confidence: 99%

“…4. A pretransplant full body functional evaluation has also shown to be helpful in identifying high-risk patients with existing MSK functional deficiencies, thereby highlighting the need for more focused rehabilitation needs during and after the transplant [10] (Figure 2). 5.…”

Section: Post-transplantmentioning

confidence: 99%

Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report

Mohammed

Smith

Burns

et al. 2019

Biology of Blood and Marrow Transplantation

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“…Finally, Figure 1 illustrates the process of RTW, which can be divided into phases or stages; some of this has already been covered under the ICF above [35][36][37][38][39][40][41][42][43][44][45][46]. [47,48]. This evaluation can help clarify the baseline values for patients' strength, endurance, psychological status, and functional capacity, all of which can be very useful when determining post-HCT RTW plans, workability, and physical workload [43,[49][50][51].…”

Section: Multidisciplinary Rtw Teammentioning

confidence: 99%

“…Although the RTW plans can commence during the patients' hospital stays, it is highly recommended that patients undergo a full functional capacity evaluation prior to HCT as many patients suffer from pretransplant comorbidities which can have a direct influence on posttransplant overall outcome [ 47 , 48 ]. This evaluation can help clarify the baseline values for patients' strength, endurance, psychological status, and functional capacity, all of which can be very useful when determining post-HCT RTW plans, workability, and physical workload [ 43 , 49 – 51 ].…”

Section: Return To Workmentioning

confidence: 99%

Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review

Mohammed

Gonzales

Bakhsh

et al. 2021

Occupational Therapy International

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The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.

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“…During the pre-and post-HSCT period, the recipients are susceptible to the toxicities of conditioning with myeloablative chemotherapy, radiotherapy, and complications resulting from HSCT, which have deleterious effects on the cardiorespiratory and musculoskeletal system. Also, the time of prolonged inactivity causes the decline of physical and functional capacity, affecting the quality of life of the patient [5,6]. Additionally, these patients develop severe thrombocytopenia, increasing their predisposition to bleeding [7,8].…”

Section: Introductionmentioning

confidence: 99%

Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation

et al. 2021

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Background During hematopoietic stem cell transplantation (HSCT) the patients perform activities of low and moderate intensity because have reduced hematological lineages, leaving them susceptible to hemorrhagic events. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients. Methods A retrospective study with seventy-seven HSCT patients hospitalised, that had a platelet count ≤ 50,000 /μL and received physical exercise during physiotherapy intervention. Results Regarding bleeding events, only six were related to physical exercise, and bleeding events occurred more frequently at platelet levels ≤ 10,000 /μL. The most frequent bleeding event was epistaxis, considered of low severity, and with the moderate possibility of being related to physical exercise; followed by extremity hematoma, considered of medium severity and highly related to physical exercise. In this study, there was no occurrence of bleeding events considered of high severity. Conclusion Bleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing HSCT is minor and relatively rare but occurs more frequently in patients with platelet count ≤10,000 /μL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications.

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Full-body physical therapy evaluation for pre- and post-hematopoietic cell transplant patients and the need for a modified rehabilitation musculoskeletal specific grading system for chronic graft-versus-host disease

Cited by 8 publications

References 5 publications

Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report

Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report

Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review

Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation

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