Functional Improvement During Prolonged Hospitalization in a Patient With Acute Myeloid Leukemia Utilizing Physical and Occupational Therapy Comanagement

Background and Purpose: Being physically active and mobile in the acute care setting has been shown to improve functional outcomes in individuals with cancer. Patient participation in occupational (OT) and physical therapy (PT) activities contributes to this; however, specific interventions and strategies are rarely described in the rehabilitation literature. Even more limited are descriptions of the purpose and implementation of OT and PT cotreatment therapy sessions. This case report describes OT and PT treatment interventions, including cotreatment therapy sessions, used in the management of a patient with prolonged hospitalization. Case Description: A 65-year-old man with a medical diagnosis of acute myeloid leukemia was admitted to the hospital for abdominal pain, dehydration, and poor appetite. His hospital course totaled 101 days and included 27 days in the intensive care unit (ICU). Medical complications included graft-versus-host disease and recurrent gastrointestinal bleeding. At therapy evaluation, voluntary motor activation was not visualized or felt during transfers. The patient had impaired balance and impaired cognition, and he needed total assistance to sit at the edge of the bed. Intervention: The patient received 13 weeks of OT and PT treatment in the ICU and continued until hospital discharge. OT and PT cotreatment therapy sessions were used throughout this period of patient care to maximize the patient's recovery of mobility and endurance. Results: At hospital discharge, the patient was independent in bed mobility and ambulation using a 4-wheeled walker. He was able to navigate 6 stair steps using handrails. For activities of daily living, he was independent in grooming, upper body dressing, toileting, lower body dressing, and showering from a seated position. Discussion: The use of both cotreatment and individual therapy sessions may be beneficial for individuals with cancer at different stages of functional recovery in the acute care setting. Cotreatment therapy sessions were used in this case when both OT and PT providers could address their different therapy goals during the same treatment session. The patient in this case report initially required total assistance for functional mobility and activity and achieved near-full independence at hospital discharge.