Medical rehabilitation and the palliative care patient

The integration of rehabilitation and palliation may sound unlikely to those who do not regularly participate in the care of patients with palliative or hospice needs. Experienced care providers, however, have long recognized the power of incorporating key elements of rehabilitation medicine into the delivery of comprehensive palliative or hospice care. In some countries, such as the UK, the integration has existed since the inception of modern hospice care and is part of palliative care. In other countries, the integration involves distinct services as well as integrated services. This chapter concentrates largely on the non-UK hospice models, especially those existing in the USA. The integration of rehabilitation medicine and palliative care is, however, of global relevance.

This integration is facilitated by a fundamental alignment between rehabilitation medicine and palliative care, which both emphasize the importance of all elements of the biopsychosocial model. Both employ interdisciplinary teams to develop care plans that respond not just to the physiological but also the psychological and social needs of patients and their caregivers. Both rehabilitation medicine and palliative care medicine seek multi-dimensional outcomes that are not related specifically to disease state, such as the functional independence measures (FIM) or, quality of life (QOL) parameters.

Rehabilitation strategies contribute to palliative care by maintaining and, if possible, promoting functional independence during a period of expected physiological decline. In addition to maximizing function through patient and caregiver training, rehabilitation strategies can prevent deleterious complications such as skin breakdown, joint contractures, pneumonia, and generalized deconditioning. The judicious selection of durable medical equipment (DME) is best done in collaboration with Physical Medicine and Rehabilitation (PM&R) specialists who can combine extensive knowledge of available componentry with an understanding of the salient medical and prognostic characteristics of a given patient.

This chapter highlights aspects of rehabilitation medicine that are of greatest value for patients requiring palliative care in hospital or hospice. Section I describes where and how such rehabilitation services can be obtained. Section II reviews the timing of rehabilitation interventions and the associated concept of functional patient goal-setting. Section III provides in-depth examples of specific rehabilitation interventions available to patients with advanced disease processes, including the important areas of caregiver training and support. Section IV examines current barriers to the effective use of rehabilitation strategies in palliative care medicine and outlines some emerging approaches for improving outcomes.