Physiotherapists

How physiotherapists address palliative care 

Physiotherapists make a difference to the quality of life of a person with a life-limiting condition by reducing common symptoms such as pain, fatigue and dyspnoea, and by improving functional capacity to retain independence and dignity.

Scope of practice

Physiotherapists assess and treat musculoskeletal, cardiorespiratory, developmental, neurological impairments that affect function, mobility and quality of life. Physiotherapists also provide education and advice about services and/or equipment. [1,2]

Members of the Australian Physiotherapy Association (APA) can view the APA’s Scope of Practice (subscription required).

Physiotherapists may have roles of advanced or extended scope of practice which reflect a level of expertise within or beyond the established contemporary scope of practice. [3,4]

Role in palliative care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [5] It is useful well before death and not limited to care of the dying. [6]

In helping people with palliative care needs, a physiotherapist: [5-10]

• is led by the person’s symptoms and their sense of what is important to them to co-create realistic goals and expectations in the face of decline and impending death within the context of a therapeutic relationship
• assesses therapy needs and appropriate therapeutic interventions
• reassesses the person’s changing care needs as their condition changes
• uses massage, range of motion or strengthening exercises, or balance training and falls prevention education to help the person manage the physical aspects of daily activities, such as walking and transfers
• provides advice on physical aids to improve mobility and management of fatigue
• educates the person, their carers and family on how to use to exercise, massage, supported positioning to reduce pain and stiffness, conserve energy and increase mobility
• teaches carers and family ways to best position, move or transfer the person
• may assist with relief of pain using techniques such as supported body positioning, hot and cold packs, massage, relaxation techniques, dry needling (additional qualifications required) and transcutaneous nerve stimulation (TENS) where clinically appropriate
• assists with pain relief for people living with dementia
• assesses and treats dyspnoea (difficulty breathing) with supported body positioning and other strategies such as breathing techniques, energy conservation techniques and use of handheld fans
• may assist the person with relaxed breathing techniques and techniques to help clear lung secretions
• assists with oedema management through positioning, exercise, compression and massage
• may be involved in lymphoedema management, additional qualifications required
• helps prevent pressure injuries through positioning and movement
• liaises within the care team to promote best outcomes
• provides support, education and training to informal carers about manual handling within the home context in order to reduce risk of injury.

Physiotherapists may work in palliative care as only part of their role or have a palliative care caseload within a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

The APA has published information for the general public about physiotherapy for palliative care.

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [11] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [12]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

Using evidence

Although physiotherapists are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

Guidelines

Codes and guidelines to provide guidance to the physiotherapy profession developed by The Physiotherapy Board of Australia are freely accessible.

Members of the Australian Physiotherapy Association (APA) can access the APA guides and guidelines (subscription required).

Guidelines specific to physiotherapy and palliative care in Australia have not been published, however, the Palliative Care Service Development Guidelines provides an overview of physiotherapy (as part of allied health) in palliative care. [12]

Irish Guidelines for the physiotherapy management of Motor Neuron Disease (MND) (1.45MB pdf). [13]

Resources for Patients, Carers and Families

Physiotherapists have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers and Families provides links to useful information including fact sheets and printable resources physiotherapists can download and share.

Education

The National Palliative Care Strategy 2018 lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [14] This is highlighted in the Essential Elements of the National Consensus Statement: Essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [15]

Courses

CareSearch lists a collection of Palliative Care eLearning resources for allied health for independent learning.