Management of Bone Metastases with Physical Therapy

Initial Risk Stratification and Contraindications

The National Comprehensive Cancer Network recommends assessing fracture and neurological risk using validated scoring systems, such as the Spinal Instability Neoplastic Score (SINS) and Mirels' score, before initiating physical therapy in patients with bone metastases 1, 2
For spinal lesions, a SINS score of ≤6 indicates stability, 7-12 suggests potential instability, and ≥13 indicates instability, guiding the decision for physical therapy or surgical consultation 1
For long bone lesions, a Mirels' score of ≤7 indicates low risk, 8 suggests moderate risk, and ≥9 indicates high risk, determining the appropriateness of exercise and the need for surgical stabilization 1
Absolute contraindications to physical therapy include a SINS score ≥13 or Mirels' score ≥9 without surgical stabilization, acute spinal cord compression, and severe hypercalcemia 1, 3

The American Cancer Society recommends aerobic exercise, such as walking, stationary cycling, and swimming, for patients with bone metastases, progressing towards 150 minutes/week of moderate intensity 4
The European Society for Medical Oncology suggests resistance training, starting with isometric exercises, to maintain muscle strength in unaffected areas, with a frequency of 2-3 sessions per week 4
Mobility and functional training, including gait training, transfer training, and balance exercises, are essential for maintaining independence and preventing falls 4

The International Bone Cancer Consortium recommends coordinating physical therapy within a multidisciplinary tumor board, including medical oncology, radiation oncology, orthopedic surgery, and rehabilitation specialists 1, 3, 5
Rehabilitation of patients with bone metastases can be safely accomplished, with low risk of pathological fractures, and demonstrates satisfactory outcomes in pain control, physical function, and quality of life 4