The Benefits of Rehabilitation for Palliative Care Patients

Abstract

Palliative care requires an interdisciplinary team approach to provide the best care for patients with life-threatening illnesses. Like palliative medicine, rehabilitation also uses an interdisciplinary approach to treating patients with chronic illnesses. This review article focuses on rehabilitation interventions that can be beneficial in patients with late stage illnesses. Rehabilitation may be useful in improving the quality of life by palliating function, mobility, activities of daily living, pain relief, endurance, and the psyche of a patient while helping to maintain as much independence as possible, leading to a decrease in burden on caregivers and family. Rehabilitative services are underutilized in the palliative care setting, and more research is needed to address how patients may benefit as they approach the end of their lives.

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…The majority of studies published focussed on patients with COPD (n=24) 4, in addition to multi-disease diagnoses studies (n=10) 1,5,[30][31][32][33][34][35][36][37] where the majority of patients in the study sample had a diagnosis of COPD. Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

“…5 Exercise is at the core of a pulmonary rehabilitation program and it works to recondition the legs and other peripheral muscles in the body to use oxygen more efficiently, therefore requiring less. 27 If patients are not able to perform physical exercise, such as in the later stages of their disease, neuromuscular electric stimulation has been shown to be effective.…”

“…Programs as short as 4 weeks have also been shown to improve health related QoL and functional exercise capacity in patients with COPD. 5 Pulmonary rehabilitation is under-utilized in palliative care possibly due to the perceived lack of cost-benefit ratio, due to limited prognoses, as well as the inaccessibility of the out-patient based clinics for this patient population. 5 For palliative care patients that may not be well enough to attend an out-patient based 12-week pulmonary rehabilitation program, a Breathlessness Support Service (BSS) with limited out-patient appointments may be an alternative option.…”

“…Even if the patient themselves can no longer benefit functionally from rehabilitation, staff can teach family members or caregivers how to improve patient comfort. 5 Palliative care on the other hand provides whole person centred-care to the patient as well as members of their circle of care including informal caregivers, family, and friends over a wide range of domains including; disease and physical symptom management, psychological, social, and spiritual well-being, assisting with practical aspects of daily living, end-of-life care and death management as well as loss and grief counselling. 6 This paper will focus on non-pharmacological pulmonary rehabilitation for patients receiving palliative care and will address specific respiratory conditions of: chronic obstructive pulmonary disease (COPD), cancer, interstitial lung disease, and Huntington's disease.…”

Rehabilitation in Palliative Care

“…[35][36][37] It can also promote the reduction of stress and positively influence the patient's perceived independence. 22 Effects of rehabilitation related to the psychosocial sphere, such as anxiety, stress and depression, were also found, as well as the patients' desire to feel physically better, even when they know that death is approaching.…”