prehabilitation and rehabilitation

Prehabilitation and Rehabilitation

Disclosure

Better Sooner and Later: Prehabilitation

Cancer rehabilitation is defined as “medical care that should be integratedthroughout the oncology care continuum and delivered by trainedrehabilitation professionals who have it within their scope of practice todiagnose and treat patients’ physical, psychological and cognitiveimpairments in an effort to maintain or restore function, reduce symptomburden, maximize independence and improve quality of life in thismedically complex population.”

What is CancerRehabilitation?

Cancer rehabilitation, similar to stroke and orthopedic rehabilitation,utilizes a multidisciplinary approach to assessment and treatment thathelps to:

•Address disease-related and treatment-related impairments;

•Decrease the number and/or severity of impairments and long-termproblems;

•Minimize survivors’ distress and disability.


Focus on screening for physical impairments (from mild

to severe) as they need to be identified and treated to

improve survivors' physical and psychological outcomes

refer cancer survivors who have problems amenable to

rehabilitation interventions to the appropriate health

care professionals who have the expertise to evaluate

and treat their physical impairments and maximize

functional status


Rehabilitation Interventions Focused on Improving Physical Health and Decreasing Disability.

Interdisciplinary Rehabilitation Team Strategies

Impairments vs. disability

Examples of Functional Assessment

Identifying Physical Impairments in Patients With Cancer

Specific Physical Impairments•Autonomic dysfunction

•Back pain

•Balance dysfunction

•Bowel dysfunction

•Cervical range of motion limitations

•Chemotherapy-induced peripheral

neuropathy

•Chest/thoracic pain

•Cognitive impairment

•Compression neuropathy

•Dystonia

•Gait dysfunction

•Graft-versus-host disease

•Headaches

•History of falls

•Jaw excursion, limited

•Joint pain, localized

•Joint range of motion limitations

•Lumbosacral plexopathy

•Lymphedema•Muscular asymmetry

•Neck pain

•Osteopenia/osteoporosis

•Paralysis

•Plexopathy

•Radiation fibrosis syndrome

•Radiculopathy

•Scapular winging

•Scar adhesions

•Sensory deficits

•Sexual dysfunction

•Shoulder pain

•Speech impairment

•Swallowing impairment

•Trismus

•Urinary dysfunction

•Visuospatial and/or proprioception dysfunction

General Physical Impairments

•Difficulty returning to premorbid activities

•Joint pain, diffuse (e.g., arthralgias)

•Musculoskeletal pain (e.g., myalgias)

•Neuropathic pain

•Somatic pain

•Visceral pain

•Weakness

•Fatigue•Deconditioning

Common Impairments Treated

Functional Disabilities

•Inability to return to work

•Difficulty caring for children/grandchildren

•Limited mobility due to safety concerns (walking, driving,

etc.)

•Inability to travel and take vacations

•Difficulty with ADLs (e.g., dressing, bathing)•Difficulty with IADLs (e.g., chores, shopping)

Common Impairments Treated

Pain

Fatigue

Neurologic Impairments

Bony Metastases

Soft-Tissue Impairments Associated With Cancer Diagnoses

Identifying Physical Impairments in Patients With Cancer

Examples of Nonmalignant Pain Due to Cancer Treatment

Cancer Rehabilitation and the Care Continuum

What is Cancer Prehabilitation?

“process on the cancer continuum of care that occurs

between the time of cancer diagnosis and the beginning of

acute treatment and includes physical and psychological

assessments that establish a baseline functional level,

identify impairments, and provide interventions that

promote physical and psychological health to reduce the

incidence and/or severity of future impairments.”


Prehabilitation is medical care that may help

newly diagnosed cancer survivors prepare for

upcoming treatments and either prevent or reduce

the likelihood of long-term problems.

Prehab focuses on effort to reduce physical

impairments, functional disability, pain and

emotional distress. This, in turn, may reduce direct

and indirect healthcare costs and ultimatelyimprove health-related quality of life.


Examples of Prehabilitation Goals

▪ Improve cardiovascular, pulmonary, and/or musculoskeletal function.

▪ Improve balance and reduce the risk of falls.

▪ Reduce anxiety and improve coping with specific cognitive behavioral

strategies.

▪ Improve quality of sleep with sleep hygiene education.

▪ Optimize surgical outcomes with smoking cessation interventions.

▪ Optimize diet with nutrition counseling.

▪ Begin preoperative pelvic floor muscle strengthening to improve

continence outcomes.

▪ Begin pretreatment swallowing exercises to improve swallowing

outcomes.

▪ Implement home safety strategies to avoid falls.

▪ Facilitate return to work with adaptive equipment.

Improving the Oncology-Rehabilitation Interface

▪ Include trained rehabilitation professionals in the formal cancer care programming,

▪ Educate all staff involved in the care of oncology patients about impairment-driven cancer

rehabilitation care.

▪ Establish a multidisciplinary cancer rehabilitation program/service line

▪ Use screening tools to identify impairments.

▪ Identify screening opportunities and integrate with appropriate on-site and/or local referral

resources.

▪ Require documentation of the navigation process, including cancer rehabilitation referrals.

▪ Track patient functional outcomes across the continuum of care beginning with a baseline

assessment.

▪ Include reassessments to identify new or ongoing rehabilitation needs.

▪ Include the patient as a partner in his/her rehabilitation care.

prehabilitation and rehabilitation

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