Transcript Oncology Rehabilitation in the Acute Care Setting

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 MEASURE
6 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 MEASURE
PERCEIVED 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
PERCEIVED EXERTION
INDEX
1
2
“Not Tired at All”
3
4
“A Little Tired”
5
6
“Tired”
7
8
“Really Tired”
9
10
“So Tired, I Cannot Go
Anymore”
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
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–
–
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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.ht
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