Occupational Therapy Guidelines for Rehabilitating People with Spinal Metastasis: Pathophysiology and Biomechanics

Occupational therapists are increasingly treating people living with metastatic spinal cancer because of advancements in cancer treatment. Specific occupational therapy guidance for serving this growing and vulnerable population is limited. This paper provides evidence for occupational therapists to expand their understanding of the pathophysiological and biomechanical reasons for spinal precautions and the importance of individualizing interventions for people with metastatic spinal cancer. Metastatic lesions can compromise bone integrity, increasing the risk of pain, fractures, and spinal cord compression, leading to irreversible neurological damage. Daily life activities create large forces in the spine, putting people with spinal metastasis at high risk for skeletal-related events (SRE). Advanced knowledge of the effects of metastatic cancer on spinal stability and biomechanics is the basis for safe and effective occupational therapy. Spinal precautions are explained using an abbreviation, “No BLT”, as a reminder to avoid bending, lifting, and twisting, simplifying the application of biomechanical principles for clinical practice. Although complete avoidance of bending, lifting, and twisting severely limits engagement in daily life, strategies that minimize the shift of the center of mass away from the spine reduce the risk of SREs, including metastatic spinal cord compression, and can increase occupational engagement leading to improved quality of life. Adaptations for activities of daily living following spinal precautions are summarized and illustrated. Occupational therapists are instrumental in enhancing meaningful engagement in daily life, and safe rehabilitation can increase the independence levels of people with metastatic spinal cancer.