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Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review.

journal contribution
posted on 07.01.2021, 05:33 by Amy Dennett, Mitchell Sarkies, Nora Shields, Casey Peiris, Cylie Williams, Nicholas Taylor

Question

What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function?

Design

Systematic review with meta-analysis of randomised controlled trials.

Participants

Adults diagnosed with cancer.

Intervention

Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors.

Outcome measures

Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach.

Results

Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported.

Conclusion

Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care.

Trial registration

PROSPERO CRD42019130593.

History

Publication Date

24/12/2020

Journal

Journal of Physiotherapy

Volume

67

Issue

1

Pagination

15p. (p. 12-26)

Publisher

Australian Physiotherapy Association

ISSN

1836-9553

Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

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