Date of Paper/Work


Type of Paper/Work

Research Project

Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Advisor

Laura Gilchrist PT, PhD


Background and Purpose: The guidelines set forth by the American Physical Therapy Association (APTA) contraindicate exercise when hemoglobin blood values are <8 g>/dL, platelets are <20,000/mL, or white blood cells (WBCs) are <5,000/mm3

accompanied by a fever. The purpose of this study was to determine if APTA hematological guidelines are appropriate for determining activity levels in children undergoing chemotherapy. The guidelines were initially established for patients with acute changes in blood values, but it has been questioned if these guidelines are appropriate for populations with chronically low blood values such as children with cancer.


A retrospective chart review was done using a consecutive sample of children with cancer being seen for physical therapy (PT) while undergoing chemotherapy. A maximum of four PT sessions per child were included for a total of 201 chart reviews. Subject’s hemoglobin, platelet, and WBC values were recorded within 24 hours of a PT session. Interventions and modifications to PT treatment were documented. The patient’s chart was reviewed for two days following the PT visit and any critical incidences as defined by the researchers were recorded.


Participants included 33 males and 40 females ranging in age from 3 to 18, with a mean age of 9.5 years. The most common cancer diagnoses were acute lymphoblastic leukemia, Wilms’ tumor, and osteosarcoma. A Fisher’s exact test showed no significant relationship between low hemoglobin, low platelets, or low WBCs and number of critical incidences (2.56, p = 0.196; 0.198, p = 0.776; 0.501, p = 0.444 respectively). A risk ratio of critical incidences in patients with low blood values versus normal blood values was iii

found to be 4.3 (CI 0.58 – 32.30) for low hemoglobin, 0.79 (CI 0.29 – 2.20) for low platelets, and 0.64 (CI 0.19 – 2.17) for low WBCs.


Results suggest there was no statistically significant evidence indicating children with chronically low platelets or WBCs were at greater risk for incidences when compared to normal values. In patients with low hemoglobin values there was an increased risk for minor events such as tachycardia. This supports our original hypothesis that a symptom-based approach in determining appropriateness for PT may be utilized in populations experiencing chronically low blood values.