Senthil P. Kumar

Physical therapy in palliative care: From symptom control to quality of life: A critical review

Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.

The California tri-pull taping method in the treatment of shoulder subluxation after stroke: A randomized clinical trial

Background: Shoulder subluxation is a frequent occurrence in individuals following a stroke. Although various methods of treatment are available, none of them address all possible consequences of the subluxation pain, limited range of motion, the subluxation, and decreased functional use of the arm. Aims: The purpose of this study was to evaluate the effectiveness of California tri-pull taping (CTPT) method on shoulder subluxation, pain, active shoulder flexion, and upper limb functional recovery after stroke. Materials and Methods: This was a randomized control study on 30 participants. All participants received conventional neurorehabilitation 5 days a week over 6 weeks. Half of the participants also received the CTPT. Pre- and post-assessment scores were taken on all participants for the amount of shoulder subluxation, pain, active shoulder flexion, and functional recovery. Results: The CTPT method demonstrated a significant reduction of pain in the treatment group from baseline, a significant improvement in active shoulder flexion and a significant improvement in proximal arm function as measured on the proximal subscale on the Fugl-Meyer upper extremity functional Scale but not the distal or total Fugl-Meyer subscales. Shoulder subluxation was not statistically significant. Conclusions: The CTPT method is an effective treatment for the hemiplegic subluxed shoulder.

Diabetic Peripheral Neuropathic Pain - An Update

Diabetic peripheral neuropathic pain (DPNP) is the clinical presentation of neuropathic pain in Painful Diabetic Peripheral Neuropathy (PDPN) and it is of two types- nerve trunk pain and hyperalgesic pain, involving both small and large nerve fiber dysfunction, secondary to insulin neuritis, glucose influx, and ectopic impulses from dorsal root ganglia, with interaction of spinal/cortical mechanisms. The paper reviews the epidemiology, mechanisms, differential diagnosis and management of DPNP and the existing evidence need to take an evidence-informed shift towards a multidisciplinary biopsychosocial perspective. The treating clinician needs to be aware of the clinical findings, neurodynamic findings, its inter-relationship with other factors such as quality of life, and scores obtained on clinical assessment scales for staging the condition so that an integrated approach involving judicious use of medical, surgical, physiotherapeutic and complementary/alternative medicine methods can be employed for comprehensive management of the condition.

Reporting of "death and bereavement care": A systematic review and quantitative analysis of research publications in palliative care journals

Context: The most common concern among terminally ill patients in palliative care is death, which is often perceived as a psychosocial stigma. The knowledge, attitudes, beliefs, and experiences regarding death influence both the delivery of palliative care and its outcomes. Aims: This study was conducted with an aim to perform a quantitative analysis of research publications in palliative care journals for articles on death and bereavement care (DBC). Settings and Design: Systematic review of palliative care journals. Materials and Methods: Twelve palliative care journals were searched for articles related to death in the title of the articles published in 2009 and 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles category was further classified according to study designs. Statistical Analysis: Descriptive analysis using frequencies and percentiles was done using SPSS for Windows version 11.5. Results: The overall reporting rate among all journals was 5.27% (96/1821), and Palliat Support Care had the highest reporting rate of 14.4% (17/118), followed by BMC Palliat Care with 9.3% (4/43) and Palliat Med with 7.4% (16/216). Conclusions: The overall reporting rate for DBC articles in palliative care journals was very low, and very few randomized clinical trials and systematic reviews were found. The study findings indicate a lack of adequate evidence base for DBC.

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

Context: Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making. Aims: To analyze the levels of evidence of articles published in IJPC in the years 2010-2011. Settings and Design: Systematic review of palliative care journals. Materials and Methods: Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication. Statistical Analysis Used: All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL). Results: There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05). Conclusions: The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.