Authors (including presenting author) :
Cheung YH (1), Fu TY (1), Fong KC (1), Chan KY (2), T Au (2), Lam WK (2)
Affiliation :
(1) Physiotherapy Department, Grantham Hospital, (2) Palliative Medical Unit, Grantham Hospital
Introduction :
Fatigue is a prevalent and distressing symptom in palliative care (PC), affecting both cancer and non-cancer patients. It has a complex etiology and can significantly impair physical function and daily activities. While evidence suggests that physiotherapy interventions, such as active exercises, can alleviate fatigue, research remains limited. To address this gap, a structured fatigue management program was implemented in a palliative daycare setting to reduce fatigue, enhance conditioning, and empower patients.
Objectives :
To evaluate the effectiveness of a structured physiotherapy-based fatigue program on fatigue and physical function in palliative patients within a daycare setting.
Methodology :
Between October 2023 and August 2024, patients in the PC daycare service were recruited for an eight-week program with the following inclusion criteria: Numerical Fatigue Rating Scale (NRS-F) scores ≥ 4 and Brief Fatigue Inventory (BFI) scores ≥ 4.
In addition to NRS-F and BFI, physical function was assessed in the first and final sessions using the following tests: Modified Functional Ambulatory Classification (MFAC), Elderly Mobility Scale (EMS), Six-Minute Walk Distance (6MWD), Timed Up and Go Test (TUG), Short Physical Performance Battery (SPPB), Single Leg Stance (SLS), and Grip Strength.
The program comprised the 5 "E"s: “Exercise Training” with 30 minutes of moderate-intensity aerobic and resistance exercises, “Easing Stress” through dyspnea control and pain management, “Energy Conservation” and “Energy Restoration” techniques, and “Empowerment” through educational booklets and home exercises.
Result & Outcome :
Sixty patients enrolled in the program, with thirty patients (9 males and 21 females, mean age: 80.3 years) completing it. Diagnoses included cancer (n=14), ESRF/CKD (n=10), IHD/HF (n=4), and others (n=2).
Significant improvements were observed in fatigue levels: mean NRS-F scores decreased from 5.0 to 2.8 (p < 0.0001; 44% decrease) and mean BFI scores improved from 5.5 to 4.1 (p < 0.0001; 25.5% decrease). Exercise tolerance, functional performance, and muscle strength also showed significant improvements: mean 6MWD increased from 178.7 to 197.2 meters (p = 0.04; 10.4% increase), mean TUG decreased from 38.3 to 26.4 seconds (p = 0.01; 31.1% decrease), and grip strength improved significantly.
In conclusion, the structured 5 “E”s physiotherapy program effectively reduces fatigue levels and improves exercise tolerance, functional performance and muscle strength in PC patients.