Physical Therapy-Based Exercise Protocol for Cancer Patients: Evaluating Outcomes for Cardiopulmonary Performance and Cancer-Related Fatigue.

BACKGROUND: Studies have shown that rehabilitation and fitness throughout cancer treatment interventions have been linked to improved outcomes for morbidity and mortality of cancer patients. This study serves to detail the efficacy of the Cancer Rehabilitation Physical Therapy Fitness and Debility (Ca PT) Program in cancer patients. OBJECTIVE: To describe the clinical population of cancer patients referred to the Ca PT Program and evaluate the efficacy of the program's therapy protocol in improving cardiopulmonary performance and cancer-related fatigue and pain. DESIGN: Retrospective study. SETTING: Outpatient clinics. PATIENTS: One hundred two adults who had been referred from a variety of referral sources and supervised individualized exercise programs. METHODS: Participation in the Ca PT Program. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was a change in baseline-to-discharge scores in the 6-Minute Walk Test (6MWT), a cardiopulmonary performance measure. The secondary measures were changes in baseline-to-discharge scores of cancer-related fatigue and general pain, measured by patient self-report using a visual analogue scale. RESULTS: 6MWT values were significantly higher at discharge (mean 523 yards) than at baseline (mean 436), (P < .001, r = 0.57). Ninety-two percent of cases showed improvement and 58% of cases had a change on the 6MWT that met threshold for minimal important difference. Quality of life factors, fatigue (P < .001) and pain (P < .001) also significantly improved. CONCLUSIONS: The results indicate the Ca PT Program yields significant improvement in cardiovascular fitness, fatigue, and pain in people with cancer history. Personalized physical therapy fitness programs for individuals recovering from cancer treatment should be a standard component of cancer intervention. LEVEL OF EVIDENCE: III.

Post-stroke fatigue: qualitative study of three focus groups.

Fatigue affects many persons after cerebrovascular accident, particularly those with mild stroke. A qualitative methodology using focus groups with 19 community-living post-stroke survivors was utilized to explore the occupational impact of fatigue as communicated by the participants. Although self-report of a small sample of the United States' post-stroke population will have limitations in generalizability, this study identifies specific health-related quality of life issues that can occur with post-stroke fatigue. The participants felt unprepared for the fatigue phenomenon and struggled to adapt, with fatigue having a debilitating influence upon daily occupational performance and roles, including social participation, return to work, driving, reading and sleeping. The participants indicated that exercise (such as walking and water aerobics) and use of assistive technology were helpful strategies in reducing fatigue. The occupational performance and role impact identified by participants in this study can inform the design of effective occupational therapy interventions and further quantitative study of persons with post-stroke fatigue.

Effects of robotic-aided rehabilitation on recovery of upper extremity function in chronic stroke: a single case study.

The objective of the study was to examine the results of robotic therapy in a single client. A 48-year-old female client 15 months post-stroke, with right hemiparesis, received robotic therapy as an outpatient in a large Midwestern rehabilitation hospital. Robotic therapy was provided three times a week for 6 weeks. Robotic therapy consisted of goal-directed, robotic-aided reaching tasks to exercise the hemiparetic shoulder and elbow. No other therapeutic intervention for the affected upper extremity was provided during the study or 3 months follow-up period. The outcome measures included the Fugl-Meyer, graded Wolf motor function test (GWMFT), motor activity log, active range of motion and Canadian occupational performance measure. The participant made gains in active movement; performance; and satisfaction of functional tasks, GWMFT and functional use. Limitations involved in this study relate to the generalizability of the sample size, effect of medications, expense of robotic technologies and the impact of aphasia. Future research should incorporate functional use training along with robotic therapy.

Outcomes of a pilot occupational therapy wellness program for older adults.

OBJECTIVE: The purpose of this study was to evaluate a pilot occupational therapy wellness program designed to teach elders the importance of participation in meaningful social and community occupations to their quality of life. METHOD: Sixty-five older adults participated in this pilot wellness program held at each of three senior apartment complexes. Measures of health-related quality of life using the SF-36 Health Survey and frequencies of social and community participation from a program-specific intake form were completed by 39 participants before and after the 6-month program. Participants also evaluated components of the program through a satisfaction survey. RESULTS: Scores on the SF-36 Health Survey were significantly higher in vitality, social functioning, and the mental health summary scores following participation in the program. Participants reported an increased frequency of socialization and community participation with an average of 55% participating in at least three or more activities per week before the program to an average of 66% participating after the program. Participants who benefited the most attended more classes, were older, and were nondrivers. Eighty percent of those polled rated the pilot program as good or excellent. CONCLUSION: This pilot study provides additional support for prevention efforts for elders in the community. Wellness programs for seniors may be most effective if targeted to those who are older and nondrivers.