Assessment of the effects of a multi-component individualized physiotherapy program in patients in a home hospice

Abstract

Introduction: Hospice care is aimed at chronically and terminally ill patients. It includes symptomatic treatment as standard, but the interest in physiotherapy programs for hospice patients is increasing in order to improve their functioning and quality of life. Aim of the study: The aim of the study is to assess the impact of a multi-component individualized physiotherapy program on the functional and mental condition and quality of life of patients in a home hospice. Material and method: The study included 60 patients (mean 66.3 years) in a home hospice living in southern Poland. Functional status was assessed twice: before and after intervention. The program was performed for 6 weeks (12 trainings) and was managed on the basis of the World Health Organization (WHO) Rehab-Cycle The International Classification of Functioning, Disability and Health (IC)F. The program was individually tailored to the patient, but structured according to the same scheme, i.e. breathing, strengthening, transfer, balance and functional exercisesas well as functional ergonomics. Patients participated in setting particular objectives of the program. The study used: Katz (ADL) and Lawton (IADL) scales, Tinetti test, Visual Analogue Scale (VAS) pain scale, WHOQOL – BREF, Yesavage Geriatric Depression Scale (GDS). A set of ICF categories in terms of function, activity and participation was selected for the studied areas. Results: The average functional level of ADL (mean 2.87) and IADL (mean 11.92) as well as quality of life (WHOQL mean 46.43) of researched patients before the intervention were low, whereas the intensity of pain (VAS mean 5.82) , the risk of falling (Tinetti mean 8.20) and depression (GDS mean 16.65) were recorded high. After the completion of the intervention program, a significant improvement was found in all assessed areas, in particular in the scope of performing basic everyday activities(ADL mean 3.95), risk of falling (Tinetti mean 12.25) and QOL (mean 52.58). Conclusions: The physiotherapeutic intervention presented here has a significant impact on improving the performance of basic and complex activities of everyday life as well as the emotional state and quality of life of patients in a home hospice. The results of our research confirm the great need for physiotherapy in hospice patients and for comprehensive assessment by means of ICF.