Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Keung LC(1), Lee YW(1)(2), Chan DM(1)
Affiliation :
(1) Occupational Therapy Department, Haven of Hope Hospital
(2) Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong
Introduction :
Exercise is a key element in cancer rehabilitation. According to the American College of Sports Medicine, in spite of having the potential to improve physical function and quality of life (QOL), the majority of people with advanced cancer remain physically inactive 30. Presence of bone metastases further complicates rehabilitation planning and patients’ compliance 6, 30. Currently, there are no clear exercise prescription guidelines for patients with bone metastases. Therapists reported uncertainties and frustrations towards the safety and efficacy of exercise prescription for this group of patients. Their concern centered on the heightened risk of skeletal-related events (SREs), including pathological fractures and spinal cord compression 30, 32.
Some systematic reviews reported the positive impact of rehabilitation for participants with advanced cancer, but with the exclusion of individuals with bone metastasis. Several international conferences addressed the importance of physical training for patients with bone metastases, potential benefits included improvement in ambulation, aerobic fitness and quality of life 7, 9, 12, 15, 17, 20-22, 28, 35, 38. Nonetheless, a paucity of randomized controlled trials were performed to evaluate the role of exercise for this target group. A systematic review with meta-analysis purely targeting bone metastases has not been investigated till now.
Improving physical function and quality of life could bring clinically meaningful benefits to patients with bone metastases. Ensuring the safety of exercise could allay both the therapists’ and patients’ concern upon skeletal-related events, to further encourage these patients to stay active in daily life. To address the aforementioned concerns, this systematic review with meta-analysis was established to evaluate the safety and efficacy of exercise for individuals with bone metastases, as a reference for rehabilitation professionals in further research and clinical practice.
Objectives :
Our objective is to determine the efficacy and safety in prescribing physical training for palliative patients with bone metastasis.
Methodology :
Pubmed, Embase and Cochrane databases were searched up to 1st April 2022. Articles were screened and selected independently by two authors, based on the defined inclusion and exclusion criteria. The assessment for risk of bias of the included randomized controlled trials (RCTs) was examined by the Cochrane risk-of-bias tool for randomized trials (RoB 2). RevMan 5.4.1 was utilized for meta-analysis.
Result & Outcome :
Results: 8 Randomized controlled trials (RCTs) were eligible for this meta-analysis, with a sum of 234 subjects equally assigned to intervention and control groups. No statistical difference in the number of adverse events was identified between intervention and control groups (standardized mean difference(SMD): -0.05 ; 95% confidence interval (CI): −0.73 to 0.64; p=0.89) with an inapplicable heterogeneity. No significant increase in bone pain was shown between groups at baseline; at the completion of radiotherapy and 6 months post-radiotherapy. Yet, significantly less pain was found in intervention groups after 3 months (SMD: -0.85, 95%CI: -1.55, -0.14, p = 0.02, 3 trials), (Chi2 = 6.89, I2 = 71%, p = 0.03). Exercise did not result in significant change in quality of life and physical function.
Conclusions:
Guided training appeared safe in early-stage palliative cancer cases with bone metastasis. No significant change in physical function and quality of life was found in this review. Future large-controlled investigation and structured exercise programmes should be developed to look into the safety and efficacy of supervised exercise.
