Table 3 The phases of rehabilitation for people who undergo autologous haematopoietic stem cell transplantation
Phase | Timinga | Setting | Assessment and treatment activities |
|---|---|---|---|
1 | Weeks −4 to 0 | Outpatient | Assessment and pre-habilitation. Baseline level of functional impairment should be ascertained, including the identification of risk factors for deterioration, with the aim of optimizing physical, social and emotional functioning and wellbeing before AHSCT. The scope of pre-habilitation is to enhance neuromuscular systems and respiratory function, and to reduce the risk of secondary complications; it includes breathing and cardiovascular exercises, management of spasticity, fatigue and pain, and cognitive rehabilitation. |
2 | Weeks 0–4 | Inpatient and early after discharge | Acute rehabilitation is patient-centred and helps to prevent hospitalization-related complications through gentle mobilization and optimization of respiratory function. Intensity of exercises should be adapted to platelet counts; exercise is contraindicated if platelet counts are below 20 × 109/l. Strict infection control measures should be in place. Individual symptoms (for example, spasticity) should be assessed and treated promptly. |
3 | Usually, weeks 8–12 | Outpatient | Subacute rehabilitation is a period of intense inpatient or outpatient rehabilitation that starts when the individual is medically stable. The aim is to optimize physical fitness, independence and the outcome of transplantation, and to treat neurological problems and any of the other disabilities. |
4 | Weeks 12–26 | Outpatient | Community rehabilitation, including vocational rehabilitation, after discharge from the hospital — this recovery phase is a continuation of the inpatient goals within the home environment. The aim is to integrate the individual back into home life, promote independence and possibly help to recover working activities. |
