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Physician referral frequency for physical therapy in children with acute lymphoblastic leukemia
Shadi Farzin Gohar1, Victoria Marchese, Melanie Comito
1Division of Pediatrics, Penn State Hershey College of Medicine at The Pennsylvania State University, Hersey, Pennsylvania, USA.
Insights
Children with acute lymphoblastic leukemia (ALL) often develop bone and muscle problems. Physical therapy (PT) can help, but few ALL patients receive it, highlighting a need for better physician awareness and integration of PT during treatment.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Hematology
Background:
- Children with acute lymphoblastic leukemia (ALL) face significant risks of musculoskeletal complications during treatment.
- The role of physical therapy (PT) in managing these complications in pediatric ALL patients is understudied.
- Understanding referral patterns for PT is crucial for optimizing care.
Purpose of the Study:
- To investigate the reasons and timing of physical therapy (PT) referrals for children undergoing treatment for acute lymphoblastic leukemia (ALL).
- To identify factors influencing PT referral patterns among pediatric oncologists treating ALL patients.
Main Methods:
- Retrospective chart review of 35 children diagnosed with ALL between 2006-2007.
- Survey of 6 pediatric oncologists regarding their PT referral practices.
- Analysis of musculoskeletal complications and PT referral data.
Main Results:
- 25 out of 35 (71%) patients experienced musculoskeletal complications.
- Only 10 (30%) of these patients were referred to PT, most commonly for decreased functional mobility.
- Physicians reported 'sometimes' referring patients, indicating inconsistent PT integration.
- Vincristine dose reduction due to peripheral neuropathy and foot drop occurred in 5 patients.
Conclusions:
- Despite recognized musculoskeletal issues in pediatric ALL, a minority of patients are referred for physical therapy (PT).
- Early and consistent integration of PT into the treatment plan is needed.
- Increased physician awareness of PT benefits is essential for improving patient outcomes and quality of life.
Abstract:
Children with acute lymphoblastic leukemia (ALL) are at risk for developing musculoskeletal complications. Few studies have examined the role of physical therapy (PT) for addressing these complications. The study objective was to examine why and when in the medical treatment, children with ALL receive a referral to PT. Retrospective chart review of 35 children, diagnosed with ALL in 2006 and 2007 at Penn State Children's Hospital was carried out. A questionnaire was completed by 6 pediatric oncologists, to identify their referral patterns. The chart review demonstrated that 25 of the 35 patients had reports of musculoskeletal complications sometime during their treatment, but only 10 (30%) were referred to PT. The most common reason for referral was decreased functional mobility. Patients were referred evenly through all phases of therapy. Vincristine was reduced in 5 patients, the most common cause being peripheral neuropathy and foot drop. The majority (5/6) of the physicians reported that they "sometimes" refer patients to PT, through different phases of therapy, with 1/3 reporting all phases. The results show that although physicians identified the musculoskeletal complications, only a minority of patients were referred for PT. This supports the need for increasing the awareness of physicians about benefits of early integration of PT into the medical treatment.
