Magro Valerio Massimo, Sorbino Andrea, Manocchio Nicola, Ljoka Concetta, Foti Calogero
Echocardiography Unit, Department of Internal Medicine and Geriatrics, University of Campania "Luigi Vanvitelli," Naples, Italy; Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy.
Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy.
Pain Manag Nurs. 2025 Jul 22. doi: 10.1016/j.pmn.2025.06.013.
Palliative rehabilitation is defined as the process of helping individuals with a progressive, often advanced or incurable disease reach their physical, psychological, and social potential consistent with physiologic and environmental limitations and life preferences. However, the evidence on this topic is very heterogeneous in the medical scientific literature and studies diverge in their results depending on both the pathologies treated and the outcome measures studied as well as the types of interventions brought to the patients. Additionally, little is known about the role of the physiatrist within palliative rehabilitation. Thus, we present a complex hematology case to highlight a team-based treatment approach that is strengthened by the physiatrist.
We studied a complex hematology patient burdened by several complications and attempted to describe our contribution on the physiatry side to his comanagement with the other specialists (hematologists, pulmonologists, infectious disease specialists, orthopedists) with whom we came into contact.
A 44-year-old male patient suffering from acute lymphoblastic leukemia resistant to chemotherapy with a history of matched unrelated donor hematopoietic stem cell transplantation came to physiatric observation with a severe general condition. Thrombocytopenia, septic manifestations, and coronavirus pneumonia were present at the time of assessment. At the visit, the patient was able to perform antigravity movements with the four limbs (strength evaluated at 3/5 according to the Medical Research Council), but because of intense pain, the Mingazzini sign in the lower limbs was never maintained for a long time. Given the patient's condition, we implemented a comprehensive individual rehabilitation project. This included a cautious motor reeducation program focusing on passive mobilization exercises, particularly of the lower limbs. Close collaboration with the orthopedic surgeon was essential to assess the risk of fracture at the femoral and pelvic levels and to appropriately dose the exercises. A respiratory reeducation program was initiated as well, incorporating therapeutic exercises that integrated breathing techniques with movement. This program included inspiratory and expiratory training and was regularly adjusted based on the patient's clinical status and response to pain management. The physiatrist's specialist contribution contributed to the global care of the patient, attempting to improve both the patient's level of dependence and his quality of life even if compromised by the disease.
The physical medicine and rehabilitation approach led to a motor and respiratory rehabilitation program that alleviated the patient's suffering and allowed him to breathe better, moving him carefully so as not to leave him immobile in bed, thus preventing the formation of pressure ulcers. Furthermore, the patient also experienced human benefits from the treatment, with a reduced sense of loneliness and positive effects on his mood.
Although a single case does not constitute significant scientific evidence, We addressed the issue of patient care together with the hemato-oncologist, in order to decide on the various aspects of the physiotherapy treatment requested in the consultation. We thus sought to establish the strengths and limitations of this treatment, its benefits and critical issues, so as to be able to clearly define its therapeutic and palliative areas, examined in the study. Physiatry in this regard can play an important role in the interaction with the various disciplines that attempt to bring relief to the patient affected by a serious pathology and severe prognosis.
Along with its well-known mission dedicated to rehabilitation, the role of physical medicine and rehabilitation can also be palliative. This means seeking to ensure, through its assessment and prescribed interventions, the best quality of life, even in patients who, due to the nature of their pathologies, their severity, and their progression, unfortunately face a poor prognosis both "quoad vitam" and "quoad valitudinem".
姑息性康复被定义为帮助患有进行性、通常为晚期或无法治愈疾病的个体，在生理和环境限制以及生活偏好的范围内，发挥其身体、心理和社会潜能的过程。然而，医学科学文献中关于这一主题的证据非常不一致，研究结果因所治疗的疾病、所研究的结局指标以及给予患者的干预类型而异。此外，关于物理医学与康复专家在姑息性康复中的作用知之甚少。因此，我们呈现一个复杂的血液学病例，以突出一种由物理医学与康复专家强化的基于团队的治疗方法。
我们研究了一位患有多种并发症的复杂血液学患者，并试图描述我们物理医学与康复团队在与其他专科医生（血液科医生、肺科医生、传染病专家、骨科医生）共同管理该患者过程中的贡献。
一名44岁男性患者，患有对化疗耐药的急性淋巴细胞白血病，有匹配无关供者造血干细胞移植史，前来接受物理医学与康复观察时全身状况严重。评估时存在血小板减少、败血症表现和冠状病毒肺炎。就诊时，患者四肢能够进行抗重力运动（根据医学研究委员会评估肌力为3/5），但由于剧痛，下肢的明加齐尼征从未长时间维持。鉴于患者的病情，我们实施了一个全面的个体化康复项目。这包括一个谨慎的运动再教育计划，重点是被动活动练习，特别是下肢的练习。与骨科医生密切合作对于评估股骨和骨盆部位的骨折风险以及适当调整练习剂量至关重要。还启动了呼吸再教育计划，纳入了将呼吸技术与运动相结合的治疗性练习。该计划包括吸气和呼气训练，并根据患者的临床状况和对疼痛管理的反应定期调整。物理医学与康复专家的专业贡献有助于患者的整体护理，即使患者因疾病而生活质量受损，也试图提高其依赖程度和生活质量。
物理医学与康复方法带来了运动和呼吸康复计划，减轻了患者的痛苦，使其呼吸更好，小心地移动他以免他长期卧床不动，从而防止了压疮的形成。此外，患者在治疗中还获得了人文关怀，孤独感减轻，情绪有积极变化。
虽然单个病例不构成重要的科学证据，但我们与血液肿瘤学家共同探讨了患者护理问题，以便就会诊中要求的物理治疗的各个方面做出决定。因此，我们试图确定这种治疗的优势和局限性、益处和关键问题，以便能够明确界定其在本研究中所考察的治疗和姑息领域。在这方面，物理医学与康复在与试图减轻受严重疾病和不良预后影响患者痛苦的各个学科的互动中可以发挥重要作用。
除了其致力于康复的众所周知的使命外，物理医学与康复的作用也可以是姑息性的。这意味着通过其评估和规定的干预措施，力求确保即使是那些由于疾病的性质、严重程度和进展，不幸在“生命”和“健康”方面都面临不良预后的患者，也能获得最佳生活质量。
