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Rehabilitation Interventions in the Multidisciplinary Management of Patients With Sclerotic Graft-Versus-Host Disease of the Skin and Fascia

Published:December 18, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.141

      Abstract

      Graft-versus-host disease (GVHD) is a multisystemic disorder that affects 30%-80% of patients who undergo allogeneic hematopoietic stem cell transplantation 10%-15% of GVHD patients develop sclerotic features affecting the skin or deeper tissues, leading to functional limitations and poor quality of life. There is limited literature regarding the indications and efficacy of specific rehabilitative interventions in sclerotic GVHD (sclGVHD). In this article, we summarize the current evidence supporting rehabilitation intervention in sclGVHD and offer our approach to the multidisciplinary management of this disease. In addition, we review techniques that have been employed in other sclerotic skin diseases (eg, iontophoresis, extracorporeal shock waves, botulinum toxin A, adipose derived stromal vascular fraction), but that require further validation in the sclGVHD setting. Ultimately, optimal care for this complex disease requires a multidisciplinary approach that includes a rehabilitation and adaptive program tailored to each patient’s needs.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), ADSVF (adipose tissue–derived stromal vascular fraction), BTA (botulinum toxin A), cGVHD (chronic graft-versus-host disease), ESW (extracorporeal shock wave), GVHD (graft-versus-host disease), HAQ (health assessment questionnaire), HEP (home exercise program), HRQOL (health-related quality of life), HSCT (hematopoietic stem cell transplant), MHISS (mouth handicap in systemic sclerosis), OT (occupational therapy), PT (physical therapy), QOL (quality of life), ROM (range of motion), sclGVHD (sclerotic graft-versus-host disease), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SLP (speech and language pathologist), SSc (systemic sclerosis), US (ultrasound)
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