-Original-

Risk of Pathological Fracture and Paralysis during Rehabilitation for Patients with Bone Metastases: A Questionnaire-Based Study

Tsunemi Kitagawa¹, Yasuyuki Kitagawa², Yoichiro Aoyagi¹ and Tokifumi Majima²

¹Department of Rehabilitation Medicine, Nippon Medical School, Tokyo, Japan
²Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan

Background: Bone metastases can cause severe pain, pathological fractures, and spinal cord paralysis, which interrupt treatment for tumors and cause patients to be bedridden. In this study, we aimed to clarify therapists' problems in the rehabilitation of patients with bone metastases and their countermeasures using the results of questionnaires to therapists and recommend safer and more rational rehabilitation.
Methods: Questionnaire forms were sent to 21 therapists in our department. The questionnaire was conducted anonymously about problems during the rehabilitation procedure such as the risk of pathological fractures and paralysis.
Results: All of the therapists had strong anxiety (43%) or some anxiety (57%) about the risk of pathological fractures or paralysis during a procedure. However, no therapist responded that this had ever occurred. Many of the respondents had changed a procedure to a milder one (81%) or interrupted a procedure (48%) due to the patient's condition on the day. Therapists chose many options to reduce the risk of pathological fractures and paralysis during the procedure. Among them, "pre-rehabilitation referral to orthopedic surgeon" (86%), "consultation with a doctor about changes in patient's symptoms and findings" (86%), and "regular cooperation between multiple occupations" (67%) were frequently selected.
Conclusions: Our questionnaire survey of therapists regarding the treatment of patients with bone metastases found that there was considerable anxiety about the risk of pathological fractures and paralysis during treatment. Our findings suggest that it is necessary to strengthen cooperation with multiple occupations, especially those in the orthopedic field.

J Nippon Med Sch 2023; 90: 326-332

Keywords
bone metastasis, rehabilitation, pathological fracture, paralysis, questionnaire

Correspondence to
Tsunemi Kitagawa, MD, Department of Rehabilitation Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
t-kita@nms.ac.jp

Received, November 23, 2022
Accepted, January 30, 2023