Physiotherapy: A New Perspective on Palliative Care

Dr Shveta Seth, New Delhi

Providing relief and comfort to patients with life-threatening conditions and their families is a crucial aspect of healthcare. While, palliative care addresses physical, psychological, social, and spiritual aspects of the patient’s well-being and aims to improve their overall quality of life, physiotherapy on the other hand, strives to optimize a patients’ quality of life and movement potential through prevention, promotion, treatment/intervention, habilitation, and rehabilitation. By utilizing physical approaches, physiotherapy aims to promote, maintain, and restore patients’ physical, psychological, and social well-being.

As a physiotherapist working in the palliative care setting, I strongly believe that physiotherapy plays a vital role in improving the well-being of patients. In palliative care, the focus is on providing comfort and relief to patients suffering from life-threatening conditions, and allied health and rehabilitation services are an integral part of achieving this goal as they encompass symptom management and minimizing the treatment effects in patients with progressive and irreversible illness.

My journey in this field began in 2009, when I joined the All India Institute of Medical Sciences in New Delhi as a Junior Physiotherapist, and was posted at the Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital (IRCH). Although I had limited exposure to palliative care during my undergraduate and postgraduate training, I was fortunate to be a part of the palliative care team under the leadership of Dr Sushma Bhatnagar, which gave me immense learning opportunities and guidance.

Within a few months at the institute, I was enthralled by this subject which further pushed me to undergo a certificate course in it. As I delved deeper into this subject, I realized the importance of physiotherapy in improving the overall well-being of patients in a palliative care environment. Improving strength, mobility training, use of assistive devices, lymphedema management, ergonomic modifications and improving respiratory functions are a few facets of physiotherapy, in a palliative setting, that can greatly improve a patient’s quality of life. With my training, I was able to utilize these concepts with much higher efficacy.

The duty of a physiotherapist is not just limited to the patients we see in an outpatient department, but also towards helping patients admitted in the wards and intensive care units. In an acute setting, such as the intensive care unit, physiotherapists can help maintain respiratory hygiene, reduce bed rest complications, and improve bed mobility especially in mechanically ventilated patients.

Physiotherapy can also help patients maintain their independence and ability to carry out their daily activities. This can significantly improve their sense of self-worth and dignity, which is particularly important for patients in a palliative care setting. Additionally, physiotherapy can aid in managing common symptoms such as pain, fatigue, and breathlessness, which can greatly impact a patient’s quality of life. By addressing these symptoms and providing tools and strategies to manage them, physiotherapy can improve the patient’s overall sense of comfort and well-being.

One of the main differences between physiotherapy in a palliative care setting and in a non-palliative care setting is ‘the intent of care’. We do not aim to treat the disease per se, but rather to manage the condition symptomatically and provide relief and comfort to patients, their families, and caregivers. A holistic approach towards patient care is critical, keeping in mind their physical, psychological, social, spiritual, and mental well-being.

To highlight the importance of physiotherapy in palliative care, I would like to discuss the case of Ms Shoba (Name changed). Ms Shoba was referred to us for the management of her lymphedema and she also had bony metastasis involving the thoraco-lumbar vertebrae. She had severe lymphedema of the right upper limb due to extensive involvement of the axillary lymph nodes. As Ms Shoba was in the palliative stage, we decided to personalize the standard management protocol to suit her needs and to maximize her comfort. So instead of providing her with compression garments, we suggested short stretch bandages along with limb elevation and active hand exercises. We decided to also use an arm sling intermittently to reduce the impact of the weight of the limb. As she was ambulatory, we advised her to use a spinal brace for supporting the spine. These person-centered measures helped in reducing her pain and kept Ms Shoba ambulatory all through her final stages. Though we were unable to significantly reduce the edema, we were able to significantly contribute towards improving Ms Shoba’s quality of life.

It is essential for primary treating physicians to refer patients to palliative care and to physiotherapy, at the right time, to reduce long-term, treatment-related adverse effects and disability. Awareness among health professionals is crucial for identifying the need for physiotherapy during the continuum of care, and appropriate referral to palliative care physiotherapy is essential for optimal and patient-centered care.

Having worked in the palliative care setting for over a decade, I have come to appreciate the importance of an interdisciplinary approach to patient care. A multi-specialized team working towards a common objective, as well as compassion towards patients, are two key aspects that help provide the best possible care to patients suffering from life-threatening conditions.

About the Author:

Ms Shveta Seth is a physiotherapist at AIIMS, New Delhi, and is a part of the pain and palliative care team for the past 12 years.

Her areas of interest include Lymphedema management and comprehensive management of cancer patients.

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