oncology rehabilitation in the acute care setting lori boright, pt, dpt, ces
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ONCOLOGY REHABILITATION IN THE ACUTE CARE SETTING
LORI BORIGHT, PT, DPT, CES
ACUTE CARE ONCOLOGY REHAB ST JOHN PROVIDENCE HEALTH SYSTEM
• Multidisciplinary– ONC REHAB Training and certification – System PTs and OTs – All levels of care
• Ambulation based cardiovascular training program for our hospital based Oncology Nursing Units
• Modeled after RMCRI– Phase 1 (During Treatment)
• Primary aim is to attenuate cancer related weakness and fatigue (CRF)
CANCER RELATED FATIGUE (CRF)• Multifactorial Etiology
– Disease process– Treatments
• Oncology patients demonstrate improvements in strength and cardiovascular status in response to goal specific exercise
• Optimal to begin program as cancer treatment commences and continue throughout
• UNCO– Acute and long-term cardio protective effects of
exercise preconditioning
PLAN OF CARE
• Newly diagnosed cancer patients should receive information regarding cancer related weakness and fatigue
– Signs and symptom recognition as well as management options across the continuum
– Lymphedema risk reduction practices if appropriate – Role of exercise interventions– Precautions and contraindications
• Referral to the oncology rehab program upon hospital admission
TARGET POPULATION
Patients who benefit include:• Patients admitted for inpatient chemotherapy
and or radiation treatment
• Oncology patients admitted due to a secondary diagnosis
– Cardiopulmonary » CHF » Decreased O2 Saturation
– Vascular » Blood Clot » Anemia
– Weakness/Debility
BENEFITS OF PARTICIPATION
• Program participants demonstrate Increased– Functional mobility– Functional independence– Cardiovascular endurance– Extremity and core strength– Standing balance– Knowledge of disease and
treatment process– Psychosocial wellbeing
INITIAL SESSION
• Standard Strength, Endurance and Mobility Assessment with ONC Emphasis – Lab Values– Vitals obtained Pre, During, Post
• Introduction to ONC Rehab• Issue Folder/Ed Materials• Conduct 6 MWT• EX prescription • Prescribe Mobility Program (currently in place at
Macomb and SJH) if indicated• Explain follow up plan of care
INITIAL SESSION PIC/FOLDER
FOLLOW UP SESSIONS
• Frequency 3X per week• Session Time 25-30 minutes
– 10-15 cardio– 10-15 strength and balance etc.
• Mobility Program utilized where indicated as supplement to program
• 6MWT• Exercise Advancement
– Seated/Standing – Balance– CV Ex – Walking Program
FOLLOW UP SESSION/BALANCE ADVANCEMENT
FUNCTIONAL MEASURE6 MINUTE WALK TEST• Evidence Based Functional Outcome Measure with
Normative Data Available• Sub-maximal measure of aerobic capacity
– Prediction Formula for VO2Max– Peak VO2=0.03xdistance(m)+3.98
• Goal to educate therapists across the continuum to utilize a consistent outcome measure
6 MINUTE WALK
FUNCTIONAL MEASUREPERCEIVED EXERTION INDEX
• Subjective measure of exercise intensity
• 1-10 scale similar to VAS for Pain
• Patients advised to NOT Exceed 4 ("a little tired") for “Phase 1” training in Acute Care Setting
12
“Not Tired at All”
34
“A Little Tired”
56
“Tired”
78
“Really Tired”
910
“So Tired, I Cannot Go Anymore”
PERCEIVED EXERTION INDEX
EQUIPMENT/CART/CONTENTS
MEASURING WHEEL
ASSISTIVE DEVICES
LBE/PEDDLER
THERABAND ETC.
VHI SOFTWARE
OT INVOLVEMENT
• Education– Energy Conservation
• Lymphedema Support
• Adaptive Equipment to assist with ADLs
EDUCATION MATERIALS
• Folder
• Program overview
• Treatment side effects
• Benefits of exercise– Target HR, Exercise Prescription
• Perceived Exertion Index
• Home Exercise Program
• Map of SJPHS OP Therapy Locations
• Community Resources
SJPHS PROGRAM DEVELOPMENT PLANS
• Secure ONC Staff Representation at each site• Continue staff education
– Train additional staff for program support– Professional Staff Education– Grand Rounds– 2nd System wide Oncology Symposium
– Anticipated for rehab staff Fall 2015
• Develop Standard Operating Procedures– Unify acute care processes across all hospital programs
• Grow program to include other hospital nursing units– IPR
• Improve transition to OP sites for seamless continuum of care
REFERENCES
• American Thoracic Society (2003). Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine. 166:1. 111-117.
• Hydock, David S., Lien, Chia-Ying, Jensen, Carol M., Hayward, Reid. Exerceise Preconditioning Provides Long-Term Protection Against Early Chronic Doxorubicin, Integrative Cancer Therapies 7 March 2011 10:47.
• Rocky Mountain Cancer Rehabilitation Institute, Workshop Manual, 2014.
REFERENCES
• Ross, Robert M., Murthy, Jayasimha N., Wollak, Istvan D., Jackson, Andrew S. The Six Minute Walk Test Accurately Estimates Mean Peak Oxygen Uptake. BMC Pulmonary Medicine 2010, 10:31.
• Wonders, Karen Hydock, David S., Schneider, Carol M., Hayward Reid. Acute Exercise Protects Against Doxorubicin Cardiotoxicity. Integrative Cancer Therapies 2008 7:147.
• RMCRI/UNCO http://www.unco.edu/rmcri/Recent_publications.html
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