Should the patient have an orthotic device? What needs to be considered?

• It should be an MDT Decision and must include the patient.
• Often required if patient has an unstable fracture and is not for surgery.
• What is the purpose of the device – stability/movement restriction or pain relief or both?
• Consider prognosis – this information is not always available so discuss with MDT whether likely to be weeks/months/years.
• Consider disease status – if the patient has bony mets only, their outlook is likely to be better therefore protecting the affected area is more of a priority.
• Quality of Life – will the device affect the patient’s comfort or ability to eat/sleep/socialise etc?
• If the patient already has significant power loss, i.e. paraplegic, will the device add any benefit?
• Skin Integrity
• Compliance – use of the device is ultimately the patient’s choice and they must be given the opportunity to make an informed decision. This discussion should not be the responsibility of the orthotist – liaise with physios and medical staff.
• Social Circumstances – how much support and help will the patient have for applying and cleaning the device?
• Is the device for life? When will the decision be reviewed?
• Who should the patient contact if there are any issues with the device?
• Who puts the device on/off?
• How many people are required to apply the device safely?

Multidisciplinary Team Working

Physiotherapy, Occupational Therapy and Orthotics should work together with ward staff to ensure high quality care for each oncology patient requiring an orthotic device. Beatson Physio team can be contacted on page 15216. Often these patients end up having a “compromise” device i.e. not the device advised on the tool but something that they can tolerate.

Malignant Spinal Cord Compression - Background Information

• The compression of the spinal cord or the nerve roots of the cauda equina.
• In 20% of cases of MSCC, this is the first indication of cancer.
• In 85% of cases it results from a bony metastases from a primary tumour
• Spinal column is the most common site of bony metastases.
• Thoracic – 70%, lumbosacral – 20%, cervical – 10%.
• Cancers of lung, prostate and breast account for about 50% of cases
• Anecdotal evidence of increasing cases within renal, bladder and oesophegeal cancers as primary treatment improves
• Highest prevalence in ages 40-65
• Occurs in 5% of all patients with cancer – this figure is likely to increase
• Is a major cause of morbidity
• Unacceptable delays in diagnosis and referral are common
• Poor functional outcomes can lead to complex discharge planning issues
• High emotional burden of symptoms and loss of function