The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

Jessica T Cheng; Obada Obaisi; Rajesh Yadav; Ekta Gupta; Jack B Fu; Eduardo Bruera; Alisha Collaco; Nicholas Szewcyzk; Uday Popat; An Ngo-Huang

doi:10.1097/PHM.0000000000002428

The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

Am J Phys Med Rehabil. 2024 Jan 8. doi: 10.1097/PHM.0000000000002428. Online ahead of print.

Authors

Affiliations

¹ Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Irvine, California.
² Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois. Cancer Center.
³ Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson, Houston, Texas.
⁴ Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 38207179
DOI: 10.1097/PHM.0000000000002428

Abstract

Introduction: Physical rehabilitation is increasingly incorporated throughout the allogeneic hematopoietic stem cell transplant (allo-HSCT) journey for older adults.

Objective: This study aimed to describe physical medicine and rehabilitation (PM&R)-related diagnoses, exercise barriers, and management recommendations for older adults before allo-HSCT.

Design: Fifty PM&R consults as part of the Enhanced Recovery-Stem Cell Transplant (ER-SCT) multidisciplinary prehabilitation program at a comprehensive cancer center were retrospectively reviewed.

Results: Many PM&R-related diagnoses (173), exercise barriers (55), and management recommendations (112) were found. Common diagnoses were musculoskeletal dysfunction (more commonly back, shoulder, then knee) (n = 39, 23%) and fatigue (n = 36, 21%). Common exercise barriers were also musculoskeletal dysfunction (more commonly back, knee, then shoulder) (total n = 20, 36%) and fatigue (n = 20, 36%). Most patients (n = 32, 64%) had 1 or more exercise barriers. Common PM&R management recommendations were personalized exercise counseling (n = 37, 33%), personalized nutrition management (n = 19, 17%), body composition recommendations (n = 17, 15%), medications (n = 15, 13%), and orthotics and durable medical equipment (n = 8, 7%).

Conclusion: Routine PM&R referral of older allo-HSCT patients for prehabilitation resulted in the identification of many rehabilitative needs and substantial additional management recommendations. Increased early, collaborative prehabilitation efforts between PM&R and allo-HSCT teams to optimize care for these patients is recommended.