Fisioterapia en una Unidad de Cuidados PaliativosEstudio basado en la práctica clínica

Resum

Introduction: Palliative care is based on a holistic approach to patients with a life-threatening illness and aims to relieve pain and any other suffering that causes physical, psychological and social problems in order to achieve the highest possible quality of life. To this end, the need to include rehabilitation and its different disciplines as a fundamental part of the teams has gradually emerged. Physiotherapy offers a non-pharmacological therapeutic alternative that should intervene during the end-of-life process to help the patient´s maximum potential in proportion to their physiological or anatomical impairment, their wishes and life plans, minimising the impact of the disease. But the lack of evidence in the field of palliative care prevents us from stating categorically that physiotherapy improves, stabilises or slows down the patient’s functionality or mobility, relieves pain and other symptoms such as fatigue, dyspnoea or muscle weakness to enhance self-confidence, and helps to preserve the sense of dignity and independence that both physiotherapy and palliative care promote. Objectives The aim of this thesis was to identify the type of patient receiving physiotherapy in a palliative care unit and to describe the benefits obtained during the length of stay receiving physiotherapy sessions as part of multidisciplinary care. Methodology An observational, prospective, descriptive and clinical practice-based observational study was conducted in which patients admitted to the Palliative Care Unit of the Hospital Fundación Instituto San José (Madrid, Spain), who met criteria for receiving physiotherapy, were included. The patients were assessed by different professionals from the palliative care team on admission to the palliative care unit, at the beginning and at the end of the physiotherapy sessions, to evaluate their condition and evolution. The scales used were the Barthel Index to analyse the degree of dependence for activities of daily living, the gait assessment scale, the functional assessment scale "palliative performance status", and the Braden scale to analyse the risk of pressure ulcers. The group of study subjects was analysed according to the reason for discharge from the physiotherapy service (exits, clinical worsening or hospital discharge). Results The most frequent patient profile in a palliative care unit was male (61.9 %) with a mean age of 71.98 ± 12.72, with presence of metastasis and with arterial hypertension and diabetes as personal history. The most frequent symptoms were muscle weakness (100 %) and pain (23.8 %). The most frequently applied physiotherapy treatment was therapeutic exercise (100 %), respiratory physiotherapy (11.1 %), analgesic techniques (11.1 %), manual therapy (6.3 %) and relaxation techniques (4.8 %). Although the improvement is reflected in all groups, the findings were statistically significant in the dependency score measured by the Barthel Index in the hospital discharge group (p=0.002). In the measurement of gait function using the FAC scale, the improvement was statistically significant in all 3 groups (p<0.001). With regard to the risk of pressure ulcers, there were statistically significant differences in the exiting and discharged groups (p=0.034). The results of the palliative functionality scale score showed statistically significant improvements in the hospital discharge group. In the entire sample, it was observed that initially many of the patients used a wheelchair to move around and at the end of the treatment, they were using a walker, cane or even walking independently, showing statistically significant changes in the 3 groups (p≤0.005). Conclusions The data suggest that the inclusion of physiotherapy as part of multidisciplinary teams brings major benefits for end-of-life patients in the degree of dependency for activities of daily living, degree of gait functionality, risk of pressure ulcer occurrence and degree of palliative functionality.