UPDATES ON MUSCULOSKELETAL ISSUES AND REHABILITATION INTERVENTIONS IN CHRONIC GRAFT-VERSUS-HOST DISEASE

Abstract

Introduction Chronic Graft versus Host Disease (cGvHD) is a long term immunological multi-organ syndrome that may occur after Allogenic Hemopoietic Stem Cell Transplantation (Allo-HSCT). Musculoskeletal issues have been considered a rare complication in cGvHD but recently these issues have been better documented and the role of rehabilitation is emerging to improve functioning in daily life, social participation and quality of life in these patients. Musculoskeletal clinical pictures of cGvHD Musculoskeletal clinical pictures of cGvHD include diagnostic signs and symptoms (fasciitis and joint stiffness/contractures), distinctive signs and symptoms (myositis and polymyositis), and other signs and symptoms as well as complications common to various types of oncological diseases. The Role of Rehabilitation Rehabilitation aims to optimize functioning and autonomy in daily activities, as well as in social life including work and school, which are major determinants for a satisfactory quality of life. In Italy a document called Rehabilitation National Plan was developed in 2011 by Italian Government and a Committee of health specialists as well as stakeholders. It defined the Italian Guidelines for Rehabilitation and proposed a unique tool for physiatrists, rehabilitation health professionals, patients and caregivers named the Individual Rehabilitation Project (IRP). For each patient the IRP described the rehabilitation programs and interventions (Therapeutic Exercise, Orthotics and aids, Occupational Therapy, Complementary and Alternative Medicine, Physical Activity) and the various involved health professionals (physiotherapist, occupational therapist, orthopedic technician, psychologist, rehabilitation nurse). Conclusions In cGvHD, Rehabilitation represents a critical step in achieving long- term health outcomes. Clinical evidence supports the relevance of referring patients to rehabilitation services as well as individualized rehabilitation interventions in dedicated facilities.

Keywords

• allogenic hemopoietic stem cell transplantion
• chronic graft versus host disease
• musculoskeletal issues
• rehabilitation