Objectives: The aim of this study is to evaluate the effectiveness of a multidisciplinary out–patient intervention (The Fatigue and Breathlessness (FAB) Program) for the palliation of breathlessness and fatigue, in advanced malignant and non-malignant disease at Marymount Hospice. The primary objective is to explore how Quality Of Life is affected by participation in the intervention. The secondary objectives are to explore how hope, functional performance, self-perceived breathlessness and self-perceived fatigue are affected by participation in the FAB program.
Methods: This is a quantitative, open label, single arm, pre-post intervention study. Patients identified by Palliative Care doctors, Community Nurses and Daycare Nurses are referred to physiotherapy for consideration of inclusion in the FAB program. Participants are included if they suffer fatigue and/or breathlessness and are under the Palliative Care Service. They are excluded if they have an unstable cardiovascular status or have a significant cognitive impairment such that they are unable to follow commands during the exercise session.
The participant attends eight group exercise sessions over four weeks and completes additional weekly unsupervised exercises at home. The circuit-type exercise session comprises of a mix of aerobic and resistance training based on the American College of Sports Medicine Exercise Guidelines for Cancer Survivors and American Thoracic Society Practice Guidelines. Exercises are modified to each individual. Pre and post-exercise measures of heart rate and oxygen saturation are measured. Eight education sessions are delivered by the multi-disciplinary team. Topics include breathing control, fatigue, anxiety management, medications, constipation, mindfulness, aromatherapy and keeping fit for life. The following validated outcome measures are assessed pre-FAB and post-FAB: McGill Quality of Life Questionnaire-Revised (McGill), Herth Hope Index (HHI), Brief Fatigue Inventory (BFI), 30 second repeated sit-to-stand (30 sec STS) and Borg Rate of Perceived Exertion (Borg).
Results: Thirty-one participants (N=31) enrolled in the study between September 2016 and April 2017. Data has been collated on n=16 participants, 48% (n=15) did not complete the study due to multiple factors. There were improvements in all of the domains tested. The McGill Quality of Life score increased by a median difference of 1.5 (range 16.5). The HHI improved by a median difference of 1.2 (range 13). The BFI improved by a median difference of .56 (range 5.3). The 30 sec STS increased by a median difference of 2.5 (range 8). The Borg improved by a median difference of 1.5 (range 8). Of these 16 participants, 14 attended at least seven of the eight sessions.
Conclusion: A multidisciplinary education and exercise program targeting fatigue and breathlessness in community-dwelling palliative care patients shows positive trends and is well received. Improvements are noted in quality of life, symptom burden and functional ability. These encouraging results add to the growing evidence that physiotherapy has an important role in enhancing quality of life and managing these symptoms in this patient cohort 1,2. Additional qualitative research would augment these findings. A limitation of this program is the high attrition rate. This is due to variations in health status, multiple hospital appointments and is a well-recognised feature of palliative care research.
References:
1. Radbruch L, Strasser F, Elsner F, Gonçalves, J Løge J, et al. Fatigue in palliative care patients — an EAPC approach. Palliative Medicine 2008;22(1):13-32.
2. Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev.2008; 16(2).
Ethical Approval: Granted by Cork Clinical Research Ethics Committee.
