Physical Function in Hospice Patients and Physiotherapy Interventions: A Profile of Hospice Physiotherapy Sinead Cobbe, M.Sc. Clinical Therapies, B.Sc. (Physio) 1 and Norelee Kennedy, Ph.D., Grad Dip (Statistics) Prof Cert Teaching and Learning, B.Sc. (Physio) 2 Abstract Objective: There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. Design: The study design consisted of a retrospective chart audit over 6 months. Setting: The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. Participants: All patients were discharged (through death or discharge onwards) from January to June 2010. Outcome measure: The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Results: Sixty-five percent were referred for physiotherapy; 58% (n = 144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1–23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received phys- iotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1–186, SD 22) whereas the median number of treatments was four (range 1–99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. Conclusion: There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life/supportive measures. The most common treatments were physical activity interventions. Introduction I n the last two decades, physiotherapy (in American terms, ‘‘physical therapy’’) has been applied to patients with cancer and other terminal illnesses in hospices and palliative care units. The aim of physiotherapy in palliative care patients is ‘‘to minimise some of the effects which the disease or its treatment has on them.’’ 1 Principles of treatment for physiotherapists working with cancer 2,3 and palliative care 4–7 have been outlined. Physiotherapy is now regarded as part of the multidisciplinary palliative team, being included in standards for service provision in Britain and Ireland. 8–10 Historically, traditional physiotherapy techniques were adapted and tailored to palliative care patients. Treatments employed included mobility/transfer training, breathlessness programs, lymphedema treatments, exercise, pain relief, edu- cation, and psychological support. 1,2,6,7,11–13 Evidence for physiotherapy in palliative patients is emerging. Exercise im- proves strength/endurance and function or slows rate of de- cline in patients with advanced cancer. 14–18 Breathlessness programs for lung cancer patients improve breathlessness, quality of life (QOL), and functional capacity and enhance coping mechanisms. 19–21 They also benefit patients with ad- vanced nonmalignant lung disease. 22 Decongestive treatments for lymphedema can be adapted for palliative care patients. 23–25 They reduce pain and dyspnea in hospice patients. 26 Physiotherapists are also involved in palliative rehabilita- tion, with evidence supporting this in both palliative and advanced cancer populations. 27–31 Furthermore, specialized palliative physiotherapy resulted in superior improvements in function, pain, and fatigue, compared with routine phys- iotherapy in hospital-based palliative patients. 32 In Ireland, hospices traditionally were nursing-led facilities involved in end-of-life care. In the last decade they have 1 Physiotherapy Department, Milford Care Centre, Castletroy, Limerick, Ireland. 2 Department of Physiotherapy, University of Limerick, Limerick, Ireland. Accepted February 20, 2012. JOURNAL OF PALLIATIVE MEDICINE Volume 15, Number 7, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2011.0480 760