NSO-05: Specialist physiotherapy post-autologous stem cell transplant improved functional outcomes with high patient satisfaction in multiple myeloma patients

Introduction: Autologous stem cell transplantation (ASCT) is offered as a front-line treatment for eligible multiple myeloma (MM) patients due to its efficacy at increasing progression-free survival. However, it is also associated with high symptom burden and reduced quality of life (QoL) which are greatest in the first-month post-ASCT. Whilst most symptoms improve by the third month, pain and reduced QoL remain prevalent for up to one year. Indicating a need for supportive care to aid recovery.
Patients who complete exercise programs pre and post-ASCT report a greater trajectory of recovery. Therefore, we evaluated the implementation of specialist physiotherapy provision introduced at 100 days (D100) post-transplant aimed to optimize patient recovery through exercise.

Methods: At University College London Hospital we conducted a service improvement project within the MM ASCT pathway. Patients seen within the D100 clinic between November 2021–December 2022 were assessed by a specialist MM physiotherapist and prescribed tailored exercises.
Outcomes included a measure of functional capacity (1-minute timed sit-to-stand test (STS-1min)), self-reported (PA) (GODIN), VAS for pain (0=no pain to 10=worst pain) and QoL (EQ5D-5L). These measures were collected at their D100 appointment (baseline) and 3 months post-D100 appointment (follow-up). In addition, an anonymous patient satisfaction survey was emailed to consenting patients upon completion of the programme.

Results: Over 1 year, 78 patients were assessed at baseline (68% male; mean age 58 years (range 42-77)). 13/78 (17%) had previous surgery and 27/78 (35%) had worn a spinal brace for MM-related bone disease. 38 patients completed a follow-up assessment within the funded time frame of the project and were included in the analysis.
There was a significant and clinically meaningful increase in functional capacity. Mean STS-1min score increased by 13 repetitions (Baseline: 23 reps, Follow-up: 36 reps; p<.001).
Significant improvements were found in PA levels (Median mod-vig PA Baseline: 0 mins per week [IQR 0–0] Follow-up: 180 mins per week [IQR 50–270] p<.001). Pain significantly reduced from 4/10 to 1/10 (p <.0 01).
From baseline to follow-up, 18 (75%) of patients had an improved QoL status, 3 (13%) had a mixed change and 3 (13%) had no change. QoL domains related to mobility and pain showed the largest improvements.
The patient satisfaction questionnaire was returned by 31/38 (81%) patients, 91% strongly agreed and 9% agreed that they felt more confident to self-manage their functional concerns after their physiotherapy consultation and it had been a valuable part of their recovery. There were no adverse events.

Conclusions: This service evaluation demonstrates the benefit of a physiotherapist assessment and individually tailored rehabilitation input as part of the ASCT pathway in MM. Results show that rehabilitation post-transplant is safe, improves patients functional capacity, PA levels, pain and QoL with high levels of patient satisfaction.