State of the Literature for Physical Therapy Interventions for Chemotherapy Induced Peripheral Neuropathy

BACKGROUND AND PURPOSE: Chemotherapy induced peripheral neuropathy (CIPN) is a common side effect in oncology patients undergoing chemotherapy treatment. CIPN may result in various physical impairments, however, there is limited research-base specific to physical therapy (PT) interventions for CIPN. Therefore, the purpose of this study is to identify the current state of research for PT interventions to help determine if sufficient evidence exists to begin formulation of a clinical practice guideline, and to identify possible PT interventions for patients with CIPN. METHODS: A scoping review was performed using the database Covidence to compile the articles. A bias assessment was performed on the articles relating to PT intervention. RESULTS: The literature search yielded a total of 18,951 articles between the year 2000 and April of 2020 investigating neuropathy in some aspect. Of this, abstract screening was completed for 3,479. 19 articles were reviewed in full for relevance to PT interventions and 10 were finally included and bias assessments were completed and 2 articles were found to be of high quality. One high quality study provided evidence that photobiomodulation (PBM) three times weekly for 6 weeks improved symptoms of CIPN, while PT including manual soft tissue mobilization along with a home exercise program (HEP) for stretching the lower extremity twice a day provided no further benefit. Another high quality study provided evidence that aerobically fit, younger, premenopausal, and healthy weight female patients respond more effectively to high intensity aerobic exercise programs than their counterparts for reduction of CIPN symptoms. Other studies were rated poor quality due to a combination of small sample sizes, poor/lack of randomization, high dropout rates, not controlling for similar background treatments, and inclusion of secondary analyses. CONCLUSION: The research suggests PT interventions for patients who develop CIPN should include: PBM (3x/week for 6 weeks) and higher intensity exercise training (50-60 minutes, 3x/week) to reduce CIPN symptoms. Additionally, age of the patient, type of cancer, menopause status and level of fitness are variables to consider before implementing these interventions. Further research is needed on this topic due to small sample sizes and poor quality of the research designs of many studies