A randomised controlled trial of a rehabilitation programme to assist physical and psychosocial recovery after stem cell transplantation

• Main Author: Bird, Lydia
• Published: University of Nottingham 2008
• Subjects: 616.02774; WH Hemic and lymphatic system
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.495059

Background Stem cell transplantation is routinely used in the treatment of haematological malignancy. However, it is an intensive treatment frequently associated with a considerable deterioration in patients' wellbeing and prolonged recovery. Research into the amelioration of the negative biopsychosocial factors associated with stem cell transplantation is essential, facilitating nurses and other health professionals to provide the best possible care to individuals who have been treated with a stem cell transplant. Study Design 58 patients who had been treated with a stem cell transplant were recruited and randomly allocated to either a health profession led rehabilitation programme or a self managed rehabilitation programme. Follow-up measures (SF-36, QHQ, Graham and Longman QoL Scale and SWT) were taken at three and six months. Qualitative interviews were conducted with 15 of the 58 participants and with five members of staff. Results In all dimensions of the SF-36 the scores of patients recovering after stem cell transplantation indicated poorer health status in comparison to UK population norms supporting the need for rehabilitation services for this patient group. No evidence of a difference between the two modes of rehabilitation was observed for any of the trial outcomes. The qualitative interview data indicated that from patients' and staff's perspectives there was scope for improvement in the rehabilitation programmes. The interview data also highlighted that staff were concerned that the trial conditions had negatively impacted the provision of rehabilitation, drawing attention to the difficulties inherent in the evaluation of complex interventions. Conclusions Existing literature, the SF-36 data collected in this study and the experiences of both patients and health professionals expressed in the qualitative component of this study all indicate that rehabilitation is an important component of health care following stem cell transplantation. However, the rehabilitation needs and desires of this patient group are complex and therefore any rehabilitation programme must reflect this complexity. Enabling patients to work collaboratively with health professionals in determining the most appropriate provision of rehabilitation may result in enhanced levels of patient satisfaction with rehabilitation services. However, the efficacy of rehabilitation following stem cell transplantation remains unproven and the provision and evaluation of patient centred rehabilitation raises numerous practical and methodological challenges.