Framework to leverage physical therapists for the assessment and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN).
Framework to leverage physical therapists for the assessment and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN).
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利用物理治疗师评估和治疗化疗引起的周围神经毒性 (CIPN) 的框架。
DOI：
10.1007/s00520-023-07734-2
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kleckner,IanR
中科院分区：
文献类型：
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作者：
Stoller,Stefanie;Capozza,Scott;Alberti,Paola;Lustberg,Maryam;Kleckner,IanR
目的化疗诱导的周围神经毒性（CIPN）是多种化疗药物引起的一种高度流行、剂量限制、昂贵且难以治疗的不良反应，表现为远端肢体的感觉和运动功能障碍。由于有限的有效治疗，CIPN可以永久性地降低患者的功能，独立性和生活质量。CIPN最有希望的干预措施之一是物理治疗，包括运动，拉伸，平衡和手动治疗干预。目前，有没有物理治疗CIPN的指南，从而限制了其吸收和潜在的effectiveness.MethodsUtilizing作者的集体专业知识跨越物理治疗，症状管理研究，肿瘤学，神经学，和治疗CIPN患者，我们提出了一个全面的临床工作流程，物理治疗师评估和治疗CIPN。这个工作流程是基于（1）物理治疗的指导方针，用于治疗神经系统症状，如那些CIPN，（2）物理治疗和运动的临床研究结果，和（3）物理治疗临床judgment.ResultsWe提出的相关物理治疗评估和治疗方法，可以在临床环境中使用的详细表格。CIPN评估应包括详细的感觉评估、受累肢体的客观力量评估，以及包含静态和动态平衡、步态和功能性移动组件的经验证的身体性能测量。CIPN治疗应该包括感觉运动，力量，平衡和以耐力为重点的干预措施，以及包括有氧训练在内的家庭运动处方。我们的结论与行动项目的肿瘤团队，物理治疗师，患者和研究人员最好地应用这个框架来解决CIPN.ConclusionsPhysical治疗师是在一个独特的位置，以帮助评估，预防和治疗CIPN的培训和患病率，但没有物理治疗CIPN的临床实践指南。我们对CIPN评估和治疗的初步建议可以促进评估和治疗CIPN的指南的发展。我们敦促肿瘤团队、物理治疗师、患者和研究人员开发、调整和传播这一框架，以帮助减轻癌症患者化疗的负担。
PurposeChemotherapy-induced peripheral neurotoxicity (CIPN) is a highly prevalent, dose-limiting, costly, and tough-to-treat adverse effect of several chemotherapy agents, presenting as sensory and motor dysfunction in the distal extremities. Due to limited effective treatments, CIPN can permanently reduce patient function, independence, and quality of life. One of the most promising interventions for CIPN is physical therapy which includes exercise, stretching, balance, and manual therapy interventions. Currently, there are no physical therapy guidelines for CIPN, thus limiting its uptake and potential effectiveness.MethodsUtilizing the authors’ collective expertise spanning physical therapy, symptom management research, oncology, neurology, and treating patients with CIPN, we propose a comprehensive clinical workflow for physical therapists to assess and treat CIPN. This workflow is based on (1) physical therapy guidelines for treating neurologic symptoms like those of CIPN, (2) results of clinical research on physical therapy and exercise, and (3) physical therapy clinical judgement.ResultsWe present detailed tables of pertinent physical therapy assessment and treatment methods that can be used in clinical settings. CIPN assessment should include detailed sensory assessment, objective strength assessments of involved extremities, and validated physical performance measures incorporating static and dynamic balance, gait, and functional mobility components. CIPN treatment should involve sensorimotor, strength, balance, and endurance-focused interventions, alongside a home-based exercise prescription that includes aerobic training. We conclude with action items for oncology teams, physical therapists, patients, and researchers to best apply this framework to address CIPN.ConclusionsPhysical therapists are in a unique position to help assess, prevent, and treat CIPN given their training and prevalence, yet there are no physical therapy clinical practice guidelines for CIPN. Our preliminary suggestions for CIPN assessments and treatments can catalyze the development of guidelines to assess and treat CIPN. We urge oncology teams, physical therapists, patients, and researchers to develop, adapt, and disseminate this framework to help alleviate the burden of chemotherapy on patients with cancer.