Purpose: This paper presents a systematic review of literature demonstrating the role of physiotherapy in the palliative management of some life limiting, non-communicable diseases like cancer, HIV, chronic bronchitis and diabetes especially as it concerns control of symptoms and prevention of disability. In addition we present the results of a case-series designed to ascertain the impact of 6 weeks physiotherapy interventions on the palliation of distressing symptoms and overall quality of life of palliative care patients managed in a Nigerian tertiary hospital.

Relevance: The study results will strengthen existing evidence for palliative physiotherapy and influence policies to inculcate physiotherapy early in palliation. Evidence of the impact of physiotherapy in palliative care may lead to consistent, early referral of patients for palliative physiotherapy. This palliation of symptoms could better the health outcome of patients.

Participants/Subjects: Seven clients consented to this study (four males and three females); two living with HIV/AIDS and five living with cancer. They were referred from the hospital’s palliative care team, general surgery department and the HIV clinic.

Methods: A systematic review on the subject matter was carried out followed by a case series conducted in a Nigerian tertiary hospital. A convenient sampling technique was adopted and extensive search conducted in PubMed Central, Google scholar and Cochrane Collaboration databases. There was no delimitation to time of publication but case reports and non English language studies were excluded. Evidence was graded using the Scottish Intercollegiate Guidelines Network 50 (SIGN 50) checklist.

Patients in this tertiary hospital received physiotherapy twice weekly for 6 weeks. The Brief Fatigue Inventory and Peak Expiratory Flow Rate(PEFR) were used to assess effect of aerobic exercises on fatigue and lung function. APCA POS and SF- 36 questionnaires were used to assess effect of physiotherapy on physical functioning, psychology and symptom control. Pain was assessed on VAS score. Further information was accessed from patient case notes as secondary data source.

Analysis: Data extracted was analyzed using simple descriptive statistics like mean, percentages, bar chart and cross-tabulations.

Results: The systematic review showed role of physiotherapy in pain, fatigue and anxiety palliation, reduction of lymphoedema, improvement of range of motion, muscle bulk, aerobic fitness and overall quality of life. The physiotherapy interventions used include massage therapy, electro-acupuncture, aerobic exercise, resistive exercise, education, complex decongestive therapy, controlled compression therapy, manual lymphatic therapy, breathing exercise, yoga and aerobics with average impact being significant(p<0.05) respectively. The result of the 7 case series (Cancer: 5, HIV: 2) is consistent with the systematic review by showing averaged positive percentage difference on Brief Fatigue Inventory(BFI) score of 33.3%, VAS (37.5%) and PEFR (47.3%). Average percentage change in POS and SF-36 scores were 14% and 56.8% respectively. The physiotherapy interventions exploited include aerobics, resistive exercise, manual lymphatic therapy, faradism, incentive spirometry and education.

CONCLUSION: All seven patients showed a trend towards improvement but a more robust, randomized controlled trial in palliative care physiotherapy is needed to reduce bias on the outcomes.

IMPLICATIONS: It can be inferred that physiotherapy interventions may alleviate distressing symptoms making medical treatment more tolerable.

KEYWORDS: Physiotherapy, Palliative care, Impact

Funding: The authors declare no sources of funding for this work.

Ethical approval: Approval was obtained from the Health Research and Ethics Committee of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu.