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Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure--the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual--and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators., The calls for integrating rehabilitation services as a component of comprehensive cancer care are numerous. (1-6) Physical therapy, which focuses on functional mobility, is an integral component of comprehensive rehabilitation [...]

Background. Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose. This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data Sources. PubMed and CINAHL were searched up to September 2018. Study Selection. Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data Extraction. Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data Synthesis. Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations. Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions. This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function., More than 15.5 million Americans have a history of cancer, and by 2026 the American Cancer Society estimates that this number will increase to 20.3 million. (1) Up to 20% [...]

The National Cancer Policy Forum (NCPF) of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) regularly convenes experts to discuss strategies needed to address high-priority [...]

highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions--medication, surgery, education, nutrition, exercise--and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. (1) Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a woman with a diagnosis of breast cancer who underwent a modified radical mastectomy with a sentinel lymph node biopsy. She subsequently received chemotherapy and radiation therapy and required episodic physical therapy to decrease impairments and improve functional limitations. Could an exercise program for the upper limb delivered preoperatively and postoperatively and along the trajectory of adjuvant chemotherapy and radiation therapy help reduce shoulder and upper extremity impairments?, More than 2.6 million breast cancer survivors currently reside in the United States. (2) Although improvements in the medical management of women diagnosed with breast cancer have resulted in a [...]