Safety and Feasibility of Rehabilitation Interventions in Children Undergoing Hematopoietic Stem Cell Transplant with Thrombocytopenia

Publication date: Available online 12 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Katarzyna Ibanez, Noel Espiritu, Regine L. Souverain, Laura Stimler, Lauren Ward, Elyn R. Riedel, Rachel Lehrman, Farid Boulad, Michael Dean Stubblefield
ObjectiveTo analyze the relationship between platelet counts, the intensities of physical therapies (PT) and occupational therapies (OT) services received, and the frequency of bleeding complications in children undergoing hematopoietic stem cell transplants (HSCT) during a period of severe thrombocytopenia.DesignRetrospective review studySettingTertiary care hospitalParticipantsChildren (age <18) hospitalized for HSCT in 2010 and 2011 who received PT and OT services while markedly thrombocytopenic (platelets≤50K/mcL).InterventionsNoneMain Outcome MeasuresIntensities of PT and OT interventions, the patients' platelet counts on specific therapy days and any bleeding events (minor or major) that occurred during or briefly following rehabilitation interventions.ResultsSixty-two patients (accounting for sixty-three HSCTs) met the criteria for analysis. Fifty-six of these patients (fifty-seven HSCTs) underwent PT and/or OT while markedly thrombocytopenic. There was no correlation between the platelet count and the intensity of rehabilitation interventions. There were no major bleeding events. There was no association between minor bleeding and intensities of PT or OT interventions and no association between minor bleeding events and platelet counts. Only 5 minor bleeding events occurred during or following moderate or intensive therapy out of 346 PT and OT sessions (1.5%).ConclusionThe results of our study suggest that bleeding complications during or following mobilization and supervised exercise during PT and OT in children with severe thrombocytopenia undergoing HSCT are minor and relatively rare. These are encouraging results for both patients and rehabilitation specialists treating this population who is at high risk for developing immobility related complications.



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