In this study of 44 pts undergoing bone marrow transplants with hematological diseases, we proposed a modest physical training to be performed during hospitalization.
A comparison was made with other studies in which pts from the same population were subjected to different rehabilitation programs and administered further assessment tests (8).
The acceptance, recruitment, and adherence to follow-up by all patients show that all well-accepted the proposed method.
We decided to administer three tests together and three times instead of individually to get a complete picture of the individual patient's performance.
These tests measure cardio-respiratory capacity, endurance, and strength of individual body districts; they are validated and used in clinical practice and reported in the literature.
We are discussing the 6' walking, strength, and Sit-to-stand tests.
The first one has been tested and validated on different patient populations and in a standardized way (9). It was used, in the beginning, to assess the functional status of patients with severe cardiopulmonary disease.
Grip strength is used in the assessment of hand and upper limb function; it's a straightforward test to perform in a few seconds. The dynamometer used for the test is an inexpensive and readily available instrument.
The Sit to Stand (STS) muscle power test proved to be a useful and, in general, more clinically relevant tool to assess the functional trend in older people. The low time, space, and material requirements of the STS muscle power test make this test an excellent choice for its application in extensive cohort studies and the clinical setting (10).
Given the tests’ feasibility characteristics, we decided to use them simultaneously by administering them to this population of transplant patients who undergo a prolonged period of inactivity.
Only a few studies report precedents following hospitalization and remote assessments (11).
To our knowledge, there are no studies in which a respiratory simulator is used in the rehabilitation protocol of this type of patient. We decided to use it to measure and motivate patients' daily respiratory performance and avoid and reduce lung complications.
To ensure patient involvement and awareness of intervention protocol, we compiled a descriptive manual of some respiratory, motor, and aerobic exercises to be given to pts.
These exercises are explained in a simple and illustrated manner, allowing the patient a reasonable degree of self-management. Multiple interventions from the nurses and doctors supported the participants during the hospitalization. However, the ease of self-management of the rehabilitation program has the limitation that physiotherapy cannot be customized to the individual patient.
The data collected show that physical and respiratory performance does not significantly reduce in terms of strength and endurance. In addition, pts report a reduction in the feeling of tiredness, measured by the Borg scale (12), through the maintenance of muscle tone and tropism.
The limitation of this study is that it is not randomized moreover can be overcome by future and more complete resources. Furthermore, the activity level was not monitored during the entire intervention but only during the hospitalization.
This model could be applied to a more heterogeneous population of cancer patients, even if not of hematological origin.
The total participation from start to finish in the study and the compliance of all patients involved suggests that the recruitment method and the interventions tested are acceptable and repeatable in other cancer patient populations.
The participants' adherence in the 3-phase assessment was always adequate, which provides input for future use on a larger scale.