The Meaning and Value of Palliative Rehabilitation Through a Case Report Analysis.

[PURPOSE] 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.

[DESIGN] 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.

[METHODS] 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.

[RESULTS] 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.

[CONCLUSIONS] 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.

[CLINICAL IMPLICATIONS] 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".