Pulmonary Rehabilitation.pdf

PREPARED BY: HANNAH MARIE V. GUMATAS, RTRP. PULMONARY REHABILITATION Presentation Slides DEFINITION Council on Rehabilitation: REHABILITATION “the restoration of the individual to the...

PREPARED BY: HANNAH MARIE V. GUMATAS, RTRP. PULMONARY REHABILITATION Presentation Slides DEFINITION Council on Rehabilitation: REHABILITATION “the restoration of the individual to the fullest medical, mental,emotional, social, and vocational potential of which he or she is capable.” DEFINITION OVERALL GOAL: to 1.) maximize functional ability and to 2.) minimize the impact the disability has on the individual, the family, and the community.  DEFINITION American Thoracic Society in conjunction with the European Respiratory Society: PULMONARY REHABILITATION multidisciplinary approach to have a comprehensive, goal- :comprehensive intervention oriented plan of care o complete patient assessment o tailored multi-disciplinary therapy and education ü to reduce symptoms ü to increase exercise tolerance ü to promote independence...to improve the physical and emotional conditions of patients with chronic respiratory diseases and to promote adherence to healthy behaviors  BREATHLESSNESS decline physical patient with chronic lung activity disease FATIGUE ü improve physical decline function independence ü improve exercise capacity unsatisfactory ü improve/ relieve quality of life from breathlessness COUGH ü improve mood ü IMPROVE MOOD CHANGES QUALITY OF LIFE X PR does not reverse or stop progression of the disease. PR helps address deconditioning and lack of ongoing disease management associated with chronic lung disease ü Improve patient’s overall quality of life HISTORICAL PERSPECTIVE EARLY Loss of Health was Aryuvedic hospitals- Romans developed Resting Institutes physical institutions TIMES thought to be best treated with rest which developed in the east called “Valetudinaria” was perhaps beneficial harbor and help the for infectious diseases Historical roots in sick. and trauma India; Written records only documented in the Primarily caring for 11th century sick slaves, gladiators, and soldiers. HISTORICAL PERSPECTIVE 19th Bed rest as a therapy reached its highest acceptance when CENTURY patients with different illnesses were places in absolute bed rest and were passively cared for by assistants and nurses. This became popularly true for patients suffering from tuberculosis and “sanatoriums” were built with the specific purpose of providing rest, good air and nutrition for these patients. HISTORICAL PERSPECTIVE 1863 First sanatorium opened in 1897 The mountainous characteristics of these locations represented Europe (Poland), for the treatment of tuberculosis. the perfect geography to develop these health resorts for -Concept that rest at high patients with tuberculosis and altitude, fresh air and good many were built in these regions. nutrition could lead to resolution and control of the disease. Sanatoriums became popular around the world, first one in the US, Adirondack Region in Saranac Lake, New York, and the first one in Canada Muskoka Ontario SANATORIUMS HISTORICAL PERSPECTIVE 1849- A Canadian pulmonologist who He also expanded excellent figures on developed tuberculosis: “He felt 1909 breathing exercises with particular emphasis on better after exercising rather exercises of the upper extremities and DR. than plain resting, wrote a book expansion of the thorax. entitled: Exercise and Food for CHARLES Pulmonary Invalids—first He also added that walking, hill climbing, bicycling and rowing were excellent exercises DENNISON scientific testimony in the field of Pulmonary Rehabilitation. that could help patients. He went on to state that these forms of exercise Recommended that exercises be are purposely graduated in order for the attending physician to know how far the patient part of the recuperative period could proceed in a given time. He felt it wise to and bed rest be limited to the have some degree of supervision by healthcare acute phases of the disease professional-- THIS IS THE INSIGHT THAT GAVE BIRTH TO PULMONARY REHABILITATION HISTORICAL PERSPECTIVE 1952- recommended Oxygen therapy and bed rest BARACH reconditioning were the modality of treatment at the time. programs for patients AND with chronic lung The lack of reconditioning COLLEGUES disease to help programs resulted in a vicious cycle of skeletal improve their ability muscle deterioration, progressive weakness and to walk without fatigue, and increasing levels of dyspnea dyspnea. HISTORICAL PERSPECTIVE OBSERVANCE: 1962 published results Patients with COPD who participated confirmed Barach’s in physical reconditioning exhibits: insight into the value lower pulse rates, of reconditioning ü ü lower respiratory rates, ü lower minute volumes, ü decreased carbon dioxide (CO2) production Reconditioning could improve both the...during exercise, without significant efficiency of motion and O2 consumption improvements in pulmonary in patients with COPD function HISTORICAL PERSPECTIVE 1969- DR. Expanded the concepts of rehabilitation for patients MID Group of pulmonary ALBERT PORTION physicians integrated with respiratory diseases. experiences in the field HAAS (NEW Developed the value of OF 20TH YORK) breathing and whole-body CENTURY exercises in patients and other thoracic surgical procedures HISTORICAL PERSPECTIVE DR. THOMAS PETTY, Eight Aspen Emphysema 1966 His co-workers applied and were granted a contract to develop and explore scientific Conference, interest basis and benefits of a comprehensive pulmonary rehabilitation program funded centered on the clinical by the Chronic Respiratory Disease Control application of many of the Program of the Public Health Service. concepts developed with integration of Description described by Dr Petty fully pharmacotherapy and resembles the current components of other surgical therapies. modern-day pulmonary rehabilitation as it included patient and family education, pharmacological strategies, breathing retraining, physical reconditioning, and optimization of oxygen therapy this program started in 1966 HISTORICAL PERSPECTIVE EARLY Introduced the specific The other major 1980’S- COPD questionnaire outcome is the looking at domains of development of field- GORDON dyspnea, fatigue, exercise tests, GUYATT AND emotional function and recognizing that most COLLEAGUES master PR patients could not be evaluated by a formal cardiopulmonary exercise test HISTORICAL PERSPECTIVE 2003- provided evidence that 2006- released their BOURBEAU ACCP and PR can reduce evidence- based hospitalizations by 40% guidelines relating to AND for patients with COPD AACVPR PR aimed at improving COLLEGUES exacerbations and the way the programs unscheduled physician are designed, appointments by 59% implemented, and when proper education evaluated through is available. patient outcomes WHO WILL BENEFIT FROM PR? Patients with chronic obstructive and restrictive pulmonary disease. WHO WILL BENEFIT FROM PR? Combined with smoking cessation, optimization of blood gas results (arterial pO2, pCO2, and pH), and proper medication use, PR offers the best treatment option for patients with symptomatic pulmonary disease. ü PR decreases healthcare utilization and hospital stays >>reducing health care cost