Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.
J Am Geriatr Soc. 2019 May;67(5):953-960. doi: 10.1111/jgs.15930.
The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown.
Two-arm single-institution randomized controlled trial of outpatient OT/PT.
Comprehensive cancer center with two off-site OT/PT clinics.
We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care.
Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs.
Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient-Reported Outcomes Measurement Information System-Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self-efficacy (Possibilities for Activity Scale [PActS]).
Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow-up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow-up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided.
OT/PT may positively influence activity expectations and self-efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953-960, 2019.
职业治疗（OT）和物理治疗（PT）对老年癌症患者功能结局的影响尚不清楚。
一项在门诊开展的 OT/PT 的双臂单机构随机对照试验。
有两个场外 OT/PT 诊所的综合性癌症中心。
我们招募了年龄在 65 岁及以上的成年人，他们最近被诊断出患有癌症或在 5 年内癌症复发，并且至少有一项功能受限，这是通过老年评估确定的。参与者被随机分配到 OT/PT 或常规护理组。
康复包括针对功能活动和力量/耐力需求的个体化 OT 和 PT。
主要结局指标是诺丁汉扩展日常生活活动量表（Nottingham Extended Activities of Daily Living scale）评估的功能状态。次要结局指标包括患者报告的测量信息系统-全球心理健康（Patient-Reported Outcomes Measurement Information System-Global Mental Health，GMH）和全球身体状况（Global Physical Health，GPH）、参与社会角色（Social Roles，SR）的能力、身体功能以及活动预期和自我效能（Possibilities for Activity Scale [PActS]）。
在招募的患者中（N=63），由于随访丢失和/或未接受干预，仅有 45 例患者（71%）可进行评估。中位年龄为 74 岁；53%为女性，91%为白人。总体而言，30%的患者患有血液系统恶性肿瘤，30%患有乳腺癌，16%患有结直肠癌。65%的患者正在接受积极治疗；49%的患者患有 3 或 4 期疾病。随访时，OT/PT 组（P=0.02）和常规护理组（P=0.03）的功能状态均有所下降。干预组的 PActS 评分组间差异有统计学意义（P=0.04）。GMH 和 SR 满足了有利于干预的最小临床差异标准，但无统计学意义。在实施干预方案时注意到了几个障碍：招募、对成本、距离、日程安排和有限的治疗的关注。
OT/PT 可能对活动预期和自我效能产生积极影响。未来的研究需要解决实施中的重大障碍，以增加 OT/PT 服务的使用和获得高质量的护理。美国老年学会杂志 67:953-960, 2019。
