Was wir noch tun können: Rehabilitation am Lebensende Potential and Possibility: Rehabilitation at end of life

"Potential and Possibility: Rehabilitation at end of life.
Physiotherapy in Palliative care"

Eds: Taylor, Simader, Nieland

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Jacob van den Broek


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Editors Comment

This book, published in both German and English versions, is a dream realised. A dream we three co-editors first conceived after an exhilarating physiotherapy pre-meeting at the European Association of Palliative Care (EAPC) conference in Vienna in 2009. In recent years physiotherapists from around the world, working in a variety of palliative/end of life care clinical settings, have been seeking to share knowledge and expertise; and it is universally acknowledged that wherever physiotherapists network together, enthusiasm is high! Our dream was consolidated in London when physiotherapists from around the world met at the `Physio Europe and Beyond` 2 day conference at St. Christopher`s Hospice in 2010. By capitalising on our creation of an EAPC Physiotherapy Task Force, strong links had been forged as a specialist professional group. The buzz of physiotherapists at the EAPC conference in Lisbon in 2011 that followed further fuelled our determination to embark on this enterprise.

This publication has come to print at a time when the barriers between countries, cultures and approaches are breaking down. More physiotherapists are being drawn to palliative care as a specialty, and the conviction grew that if we are to enhance our important role as specialist physiotherapists improving the quality of life for patients at the end of life, we can do much more together than we can in isolation.

Moreover, in a context of improved survivorship, growing numbers of physiotherapists in all specialties will encounter precisely the challenges demanding and benefiting from the knowledge, and most of all, skills we can share. Palliative care clinical skills of the specialist physiotherapist are ever more widely applicable; from paediatric to elderly care, from acute hospital settings to hospices, and from the bedside to the gymnasium. But aside from that, there is also a particular attitude needed from the health professional towards patients at the end of life. The palliative care physiotherapist exemplifies the empathetic and holistic approach needed to reach complex, changing, and realistic goals. Patient empowerment and self-help is key, and in the more pressured and constrained climate in health care generally today, this is a model that can be usefully taught. Future research and education in this field will always be paramount, and hopefully this publication will contribute to engender ideas and discussion. While the development of physiotherapy techniques and best practice at end of life is the primary aim, disseminating our skills, many of them transferable, to other multi-professional clinicians is a worthy goal.

We have endeavoured to include a comprehensive range of topics, presented in a case-specific, accessible, and user-friendly format, which aims to be a useful resource in a variety of settings. In view of the many nationalities and contexts of our contributors, the editors have utilised red `stop` and green `go` boxes as a continuous theme running through many of the chapters to highlight key precautions and helpful strategies. We hope that this format really helps to direct and assist the reader. Our intention is that this volume is not only a source of clinical knowledge, but also opens up debate and thinking around physiotherapy education and training, both given and received.

Educational requirements for entry to the physiotherapy profession vary from country to country. Professional autonomy differs. In some countries rehabilitation, if not contra-indicated, is seen as revolutionary to patients at end of life. Differences in approach are a `given` and rather than feeling defensive as a profession we must embrace these differences and use them as a catalyst for ongoing analysis and re-evaluation. But beyond these considerations, we know that wherever physiotherapists are privileged to work alongside these universally vulnerable patients, our clinical practice constantly evolves. So, to encourage the development of practice in the workplace, reflective questions have been included in the case studies with the intention of provoking discussion and analysis. As co-editors we have aimed to stimulate debate and inspire innovation. Practice for all of us evolves in a changing landscape; so by challenging our own thinking maybe we will contribute to creating a powerful vision towards growth and change for future models of physiotherapy practice?

Importantly, we also hope to attract interest from other professionals in the field to enhance their understanding of our role. It is without doubt that we must raise our profile to encourage health care commissioners in every country to recognise the major contribution we can make as a professional group to end of life care; not only in delivering symptom control and rehabilitation excellence but, significantly in these challenging times, in overall patient cost-effectiveness.

Jenny Taylor, Rainer Simader, Peter Nieland