Understanding The Role of Physiotherapy in a Hospice Setting. Article of The Week #5

Every Monday you will find a top quality research study summarised for you here on Physiospot. The articles are chosen as  they are high quality and high impact and likely to shape your clinical practice. After all it’s difficult finding the gems in all the research that’s published daily. So let us do the hard work for you. 

Understanding the role and scope of a physiotherapist working in a Hospice setting can be difficult to understand. To a lot of clinicians it is a foreign environment to work in and can be hard to intuitively understand and apply the traditional role of our profession to. Traditional physiotherapy education will make sure you know how to screen for cancer as a red flag but not how we can improve the quality of life for those approaching their final few months of life.

This systematic review set out to address the following questions:

  1. What are the various physiotherapy interventions addressing the symptoms of patients with advanced cancer in a hospice setting?
  2. What are the characteristics (dose, duration, type and intensity) and effects of physiotherapy interventions in this setting?

This was achieved by performing a systematic review which adhered to PRISMA and utilised a thorough search strategy as well as using a modified Down’s and Black’s checklist for methodological rigour of included studies. Initially some 2102 articles were obtained using the search strategy and this was reduced to 9 articles. The methodology is clear and easy to understand throughout the article. Overall the studies included were of low to moderate quality but that is often the case in studies such as this due to high drop out rates (in this case death), inability to perform RCTs (limitations in this population) and small sample sizes. That being said there is no excuse for publishing an article with missing data and that was the case for several articles included within the review.

The Results

Physical Function

The symptoms patients with advanced cancer suffer from results in a diminished physical performance because of reduced strength, endurance which reduced independence. The results of the systematic review suggest that a structured exercise intervention is beneficial in improving physical function and maintenance rather than progression should be the focus. The optimum mode of exercise is unclear this is likely due to lack of heterogeneity of the patient group.


There are many factors which affect fatigue in this population including; insomnia, anaemia, inflammation and pain. The results of this review suggest that cardiovascular and resistance training were effective at reducing the intensity of fatigue.


About 66.4% of patients with advanced cancer have pain and this systematic review suggests that TENs is an effective and feasible pain management strategy alongside opiates in this stage of cancer. Physiotherapy intervention should only be seen as an adjunct.


Compression bandage and massage are well known effective management techniques for lymphodema and this should continue.

Clinical Implications

This systematic review demonstrates the scope and role of physiotherapy in a hospice setting and how we can help patients in the final months of life have as much quality of life as much as possible. Overall structured exercise, therapeutic massage, TENs and compression bandaging for lymphodema are all worthwhile interventions to use in this setting to improve quality of life.

An Introduction to Red Flags
When assessing patients in clinical practice, it is always essential to consider serious pathology as a differential diagnosis. Red flag screening questions were developed to help detect these pathologies, but there is limited evidence to support their use. So how should clinicians be using red flags and how do they know when to take action? This course aims to provide you with an understanding of red flags and how they can be used effectively in clinical practice.

Do You Know How to Screen for Red Flags?