Palliative Care Competence Framework for Physiotherapists

Welcome to Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice project. This space was created by and for the students at Queen Margaret University in Edinburgh, UK. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

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Introduction and Learning Outcomes

Aims

The aim of this wiki is to present a learning resource for final year physiotherapy students and new graduates to develop their knowledge and understanding of:

1. The role of a physiotherapist in the management of people with lymphoedema
2. The implications for physiotherapy practice when managing people with lymphoedema in a palliative care setting

Learning Outcomes

By the end of this wiki you should be able to:

1. Discuss the background of lymphoedema and describe the key presenting symptoms
2. Discuss the physiotherapist’s role in the management of people with lymphoedema
3. Critically reflect on the physiotherapist’s approach in the management of people with palliative care needs who have lymphoedema
4. Critically appraise and synthesise the literature relating to the end of life care for a person with lymphoedema

Treatment and Management of Lymphoedema

Introduction and History

The Lymphoedema Framework (2006) states that the treatment of people with lymphoedema should be specifically tailored based on the site, severity and complexity as well as their psychosocial situation. Furthermore the success of treatment does not solely rest on the therapist, patients and carers must play an active role from an early stage.

Alongside the physical difficulties that people with lymphoedema face, emotional and social implications may also arise. Evidence has suggested that through specific management and targeting of the physical symptoms, the psychosocial issues can be reduced to enhance the individual’s quality of life (Kim and Park 2008).

Decongestive lymphatic therapy (DLT) is viewed as the gold standard of care for lymphoedema (Chang and Cormier 2013). Kim and Park (2008) found this treatment approach effective and significantly reduced the percentage excess limb volume as well as improving quality of life.

Decongestive lymphatic therapy encompasses four main components (Todd 2009);
• Compression
• Skin care
• Exercise
• Massage

The management of lymphoedema is split into intensive and maintenance stages, both of which have very different approaches. The goals during the intensive stage of therapy are to reduce and control the swelling, maintain skin quality and educate the patient in order for them to reach a stage where they are ready to progress into the maintenance phase of treatment (Korpan et al. 2011). This is achieved through a number of approaches aiming to reduce the load and decongest the lymphatic system, stimulate the function and encourage drainage through various routes (Lymphoedema Framework 2006). Once swelling is bought under control patients will progress to the maintenance stage. During this stage people with lymphoedema are educated to self manage their condition and will be reviewed less frequently by a specialist.

Over the next four sections of this wiki you will learn more about each of the components of DLT.

Take 5 minutes -
Can you…

• Think of any psychological issues that you may encounter if treating a patient with lymphoedema?
• Name the four cornerstones of lymphoedema treatment?
• List the goals during intensive therapy?

By this stage you should be able to identify the four cornerstones of DLT and state the general aims of the intensive and maintenance stages of treatment.

Over the next section this wiki will discuss the four components of DLT in detail with reference to the supporting evidence.

References

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