Activity Level for Patients with Bone Metastases
A Guide for Physical and Occupational Therapists
Presence of
Bone Metastasis
Old Diagnosis
New Diagnosis
Location in spine
Bedrest until work-up
completed
Location in NWB bone
Location in WB bone
Bedrest until work-up
completed
Prior to mobility:
 General activity
orders
Location in WB bone or spine
Location in NWB bone
Prior to mobility:
 General
activity orders
(+) change in pain level
in area of bone
metastasis
(-) change in pain
level in area of
bone metastasis
Bedrest until work-up
completed
(+) impending fx
(+) pathologic fx
(+) impending fx
(+) pathological fx
(-) impending fx
(-) pathologic fx
(-) impending fx
(-) pathological fx
Treat as new
diagnosis
Prior to mobility:
 General activity
orders
 WB orders for
involved extremity
from orthopedics
Prior to mobility
 General activity
orders
 Spine clearance by
orthopedics or
neurosurgery consult
 Patient education on
spine precautions
Prior to mobility:
 General activity
orders
 Patient education
on spine
precautions
(+) pain
Prior to mobility:
 General activity orders
 Consider assistive
device if metastasis is
in lower extremities
(-) pain
Prior to mobility:
 General activity
orders
Research clinic
notes or previous
inpatient notes for
mobility
recommendations
and precautions
Guidelines for working with
patients with bone metastases:
 Patient and caregiver should
understand risks and benefits
of mobilization versus
bedrest
 Limit activity to pain-limited
active range of motion
 Do not perform manual
muscle testing or resistance
training to involved extremity
Evidence Table by Amy Kushner, PT
Flow chart created by Emily Sourisak, PT & Elizabeth Stauffer, SPT, MHS
References on page 2
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References
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Bunting RW, Shea B. Bone metastasis and rehabilitation. Cancer Rehabilitation in the New Millenium.
Supplement to Cancer. 2001; 92(4):1020-1028
Bunting RW, Boublik M, Blevins FT, et al. Functional outcome of pathological fracture secondary to
malignant disease in a rehabilitation hospital. Cancer. 1992; 69:98-102.
Johnson, SK & Knobf MT. Surgical interventions for cancer patients with impending or actual pathologic
fractures. Orthopaedic Nursing. 2008; 27(3):160-171.
Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosis impending pathological
fractures. Clin Orthop 1989; 249:256-264.
Struthers C, Mayer D, Fisher G. Nursing management of the patient with bone metastases. Seminars in
Oncology Nursing. 1998; 14(3):199-209.
Weber KL, Randall RL, Grossman S, Parvizi J. Management of lower-extremity bone metastasis. J Bone
Joint Surg Am. 2006; 88:11-19.
Content of flow chart generated by Fran Collichio, MD and Emily Sourisak, PT in consultation with Jordan Renner,
MD, Eldad Hadar, MD, and Robert Escher, MD.
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