Pulmonary Rehabilitation - PowerPoint PPT Presentation


Title: Pulmonary Rehabilitation


1
Pulmonary Rehabilitation
2
What is Pulmonary Rehabilitation?
  • Pulmonary Rehabilitation is an evidence
    based, multidisciplinary, and comprehensive
    intervention for patients with chronic
    respiratory diseases who are symptomatic and
    often have decreased daily life activities.
  • Integrated into the individualized treatment
    of the patient, pulmonary rehabilitation is
    designed to
  • reduce symptoms
  • optimize functional status
  • increase participation
  • reduce health care costs
  • through stabilizing or reversing systemic
    manifestations of the disease.
  • American Thoracic Society/ European
    Respiratory Society Statement on Pulmonary
    Rehabilitation 2005 American Journal Critical
    Care Medicine Vol 173, pp 1390 1413. 2006

3
Who is Pulmonary Rehabilitation for?
  • In general, people who have underlying chronic
    lung disease and are limited by dyspnoea.
  • Partners or caregivers should also be
    encouraged to attend.

4
  • The Primary Aims of Pulmonary Rehabilitation are
  • To reduce disability and handicap of people with
    chronic lung diseases.
  • To restore people to the highest possible level
    of independent functioning.

5
  • The Goals of Pulmonary
  • Rehabilitation are to
  • Increase exercise tolerance in order to reduce
    impairment.
  • Improve adherence to recommended treatments.
  • Reduce frequency and severity of symptoms.
  • Improve mood and motivation.
  • Reduce dependency.
  • Enhance participation in therapy decisions by
    building self-management capacity.
  • Increase participation in everyday activities.
  • Improve quality of life.
  • Reduce health care burden for patients, families
    and communities.
  • Improve survival.

6
  • A number of Pulmonary Rehabilitation Guidelines
    have been published
  • National Institute for Clinical Excellence (NICE)
    2004
  • Global Initiative for Chronic Obstructive Lung
    Disease 2005. 
  • American Thoracic Society/European Respiratory
    Society Statement on Pulmonary Rehabilitation
    (2005)
  • Joint American College of Chest
    Physicians/American Association of Cardiovascular
    and Pulmonary Rehabilitation Evidence-Based
    Clinical Practice guidelines (CHEST 2007)
  • BTS Statement on Pulmonary Rehabilitation (THORAX
    2001)
  • Pulmonary Rehabilitation toolkit (2006)

7
Eligibility Criteria
  • Include patients who
  • Have stable chronic obstructive pulmonary disease
    or other respiratory conditions without acute
    illness.
  • Are willing to participate (even if they are
    current smokers).
  • Exclude patients who
  • Have severe cognitive impairment.
  • Have severe psychotic disturbance.
  • Have a relevant infectious disease.
  • Exclude patients from the exercise component if
    they have
  • Musculoskeletal or neurological disorders that
    prevent gentle exercise.
  • Unstable cardiovascular disease (e.g. unstable
    angina, aortic valve disease, unstable pulmonary
    hypertension).
  • Known metastatic cancer.

8
Assessment Tools
  • Six Minute Walk Test (SMWT)
  • Shuttle Walk Test (SWT)
  • Medical Research Council (MRC) Dyspnoea scale
  • 0 breathless only on strenuous activity to
  • 4 too breathless to leave the house or breathless
    when dressing
  • Hospital Anxiety and Depression Scale (HADS)
  • Chronic Respiratory Questionnaire (CRQ)
  • St Georges Quality of Life Questionnaire
  • BODE
  • Predictor of mortality at 5 years in COPD based
    on scores from
  • B Body Mass Index
  • O Obstruction (FEV1)
  • D Dyspnoea (MRC scale)
  • E Exercise tolerance (6MWT/SWT)

9
Intervention Strategies
  • Exercise physiotherapist led
  • improve motivation
  • reduce mood disturbance
  • decrease symptoms
  • improve cardiovascular function
  • Should exercise at least 3 times a week so
    need to be doing some at home
  • Aiming for high intensity upper and lower
    body exercise, endurance and strength training
  • Education multidisciplinary
  • Relaxation
  • Support and sharing of experiences

10
Education Topics
  • Benefits of exercise breathing control.
  • Goal Setting
  • What is COPD?
  • Medication Inhaler/spacer devices
  • Energy Conservation Coping Strategies
  • COPD Self Management Plan
  • Stress Reduction, Relaxation Anxiety Management
  • Nutrition
  • Smoking Cessation
  • Sleep Services
  • Loving relationships sexuality
  • Continence etc etc
    etc.

11
Multi Disciplinary Team
  • CNS
  • Physiotherapist Community Physiotherapist
  • Clinical Psychologist (CHCH)
  • Consultant Physician
  • Occupational Therapist
  • Pharmacist
  • Dietitian
  • Social Worker
  • Speech Language Therapist
  • Continence Nurse
  • Green Prescription Coordinator
  • Respiratory Relief - support group

12
Course Format
  • 6 - 12 week programme of exercise education.
    Participants attend twice a week for 2 hours then
    exercise at home another day.
  • Pre and post assessments
  • Patients given booklet of resources

13
What can you do?
  • Referrals to pulmonary rehabilitation
    programs can come from
  • Hospital inpatient or outpatient departments.
  • Respiratory specialists
  • Clinical Nurse Specialists.
  • Allied health professionals.
  • General practitioners.
  • General physicians.
  • Community health professionals.
  • A referral form should be provided to the
    coordinator of the pulmonary rehabilitation
    program.  
  • The coordinator would normally be a health
    professional in charge of running the program. 

14
Summary
  • The structure and delivery of programs are
    diverse and dependent upon available resources,
    but the aims remain the same.
  • Pulmonary Rehabilitation is an integral part of
    the clinical management of all patients with
    chronic respiratory disease

15
Summary cont
  • Comprehensive Pulmonary Rehabilitation has been
    shown to
  • Improve QOL
  • Reduce emotional morbidity
  • Improve exercise performance
  • Improve functionality and confidence
  • Reduce both primary admissions and readmissions
    to hospital.

16
Summary cont
  • Despite the benefits shown, studies reveal that
    fewer than 1 of patients with moderate to severe
    COPD are receiving Pulmonary Rehabilitation per
    annum (approx 1 in 200).

17
A former participant was so impressed about her
experience in Pulmonary Rehabilitation that she
wrote the following poem.
  • I was breathing very badly
  • So I gave the doctor a call,
  • The hospital then sent me
  • To the horticultural hall.
  • Lovely young therapists
  • Made sure I didnt fall,
  • And every week a
    specialist

    Gave lectures to us all.

  • Then I learnt to lift my leg

  • And bend and kiss the wall,

  • And other exercises like

  • Bouncing a great big ball.

  • Many happy memories

  • Im sure I will recall,

  • So thank you
    for inviting me

  • To the
    horticultural hall.

18
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Pulmonary Rehabilitation

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Title: Pulmonary Rehabilitation


1
Pulmonary Rehabilitation
2
What is Pulmonary Rehabilitation?
  • Pulmonary Rehabilitation is an evidence
    based, multidisciplinary, and comprehensive
    intervention for patients with chronic
    respiratory diseases who are symptomatic and
    often have decreased daily life activities.
  • Integrated into the individualized treatment
    of the patient, pulmonary rehabilitation is
    designed to
  • reduce symptoms
  • optimize functional status
  • increase participation
  • reduce health care costs
  • through stabilizing or reversing systemic
    manifestations of the disease.
  • American Thoracic Society/ European
    Respiratory Society Statement on Pulmonary
    Rehabilitation 2005 American Journal Critical
    Care Medicine Vol 173, pp 1390 1413. 2006

3
Who is Pulmonary Rehabilitation for?
  • In general, people who have underlying chronic
    lung disease and are limited by dyspnoea.
  • Partners or caregivers should also be
    encouraged to attend.

4
  • The Primary Aims of Pulmonary Rehabilitation are
  • To reduce disability and handicap of people with
    chronic lung diseases.
  • To restore people to the highest possible level
    of independent functioning.

5
  • The Goals of Pulmonary
  • Rehabilitation are to
  • Increase exercise tolerance in order to reduce
    impairment.
  • Improve adherence to recommended treatments.
  • Reduce frequency and severity of symptoms.
  • Improve mood and motivation.
  • Reduce dependency.
  • Enhance participation in therapy decisions by
    building self-management capacity.
  • Increase participation in everyday activities.
  • Improve quality of life.
  • Reduce health care burden for patients, families
    and communities.
  • Improve survival.

6
  • A number of Pulmonary Rehabilitation Guidelines
    have been published
  • National Institute for Clinical Excellence (NICE)
    2004
  • Global Initiative for Chronic Obstructive Lung
    Disease 2005. 
  • American Thoracic Society/European Respiratory
    Society Statement on Pulmonary Rehabilitation
    (2005)
  • Joint American College of Chest
    Physicians/American Association of Cardiovascular
    and Pulmonary Rehabilitation Evidence-Based
    Clinical Practice guidelines (CHEST 2007)
  • BTS Statement on Pulmonary Rehabilitation (THORAX
    2001)
  • Pulmonary Rehabilitation toolkit (2006)

7
Eligibility Criteria
  • Include patients who
  • Have stable chronic obstructive pulmonary disease
    or other respiratory conditions without acute
    illness.
  • Are willing to participate (even if they are
    current smokers).
  • Exclude patients who
  • Have severe cognitive impairment.
  • Have severe psychotic disturbance.
  • Have a relevant infectious disease.
  • Exclude patients from the exercise component if
    they have
  • Musculoskeletal or neurological disorders that
    prevent gentle exercise.
  • Unstable cardiovascular disease (e.g. unstable
    angina, aortic valve disease, unstable pulmonary
    hypertension).
  • Known metastatic cancer.

8
Assessment Tools
  • Six Minute Walk Test (SMWT)
  • Shuttle Walk Test (SWT)
  • Medical Research Council (MRC) Dyspnoea scale
  • 0 breathless only on strenuous activity to
  • 4 too breathless to leave the house or breathless
    when dressing
  • Hospital Anxiety and Depression Scale (HADS)
  • Chronic Respiratory Questionnaire (CRQ)
  • St Georges Quality of Life Questionnaire
  • BODE
  • Predictor of mortality at 5 years in COPD based
    on scores from
  • B Body Mass Index
  • O Obstruction (FEV1)
  • D Dyspnoea (MRC scale)
  • E Exercise tolerance (6MWT/SWT)

9
Intervention Strategies
  • Exercise physiotherapist led
  • improve motivation
  • reduce mood disturbance
  • decrease symptoms
  • improve cardiovascular function
  • Should exercise at least 3 times a week so
    need to be doing some at home
  • Aiming for high intensity upper and lower
    body exercise, endurance and strength training
  • Education multidisciplinary
  • Relaxation
  • Support and sharing of experiences

10
Education Topics
  • Benefits of exercise breathing control.
  • Goal Setting
  • What is COPD?
  • Medication Inhaler/spacer devices
  • Energy Conservation Coping Strategies
  • COPD Self Management Plan
  • Stress Reduction, Relaxation Anxiety Management
  • Nutrition
  • Smoking Cessation
  • Sleep Services
  • Loving relationships sexuality
  • Continence etc etc
    etc.

11
Multi Disciplinary Team
  • CNS
  • Physiotherapist Community Physiotherapist
  • Clinical Psychologist (CHCH)
  • Consultant Physician
  • Occupational Therapist
  • Pharmacist
  • Dietitian
  • Social Worker
  • Speech Language Therapist
  • Continence Nurse
  • Green Prescription Coordinator
  • Respiratory Relief - support group

12
Course Format
  • 6 - 12 week programme of exercise education.
    Participants attend twice a week for 2 hours then
    exercise at home another day.
  • Pre and post assessments
  • Patients given booklet of resources

13
What can you do?
  • Referrals to pulmonary rehabilitation
    programs can come from
  • Hospital inpatient or outpatient departments.
  • Respiratory specialists
  • Clinical Nurse Specialists.
  • Allied health professionals.
  • General practitioners.
  • General physicians.
  • Community health professionals.
  • A referral form should be provided to the
    coordinator of the pulmonary rehabilitation
    program.  
  • The coordinator would normally be a health
    professional in charge of running the program. 

14
Summary
  • The structure and delivery of programs are
    diverse and dependent upon available resources,
    but the aims remain the same.
  • Pulmonary Rehabilitation is an integral part of
    the clinical management of all patients with
    chronic respiratory disease

15
Summary cont
  • Comprehensive Pulmonary Rehabilitation has been
    shown to
  • Improve QOL
  • Reduce emotional morbidity
  • Improve exercise performance
  • Improve functionality and confidence
  • Reduce both primary admissions and readmissions
    to hospital.

16
Summary cont
  • Despite the benefits shown, studies reveal that
    fewer than 1 of patients with moderate to severe
    COPD are receiving Pulmonary Rehabilitation per
    annum (approx 1 in 200).

17
A former participant was so impressed about her
experience in Pulmonary Rehabilitation that she
wrote the following poem.
  • I was breathing very badly
  • So I gave the doctor a call,
  • The hospital then sent me
  • To the horticultural hall.
  • Lovely young therapists
  • Made sure I didnt fall,
  • And every week a
    specialist

    Gave lectures to us all.

  • Then I learnt to lift my leg

  • And bend and kiss the wall,

  • And other exercises like

  • Bouncing a great big ball.

  • Many happy memories

  • Im sure I will recall,

  • So thank you
    for inviting me

  • To the
    horticultural hall.

18
(No Transcript)
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