SM

Ch 2: Notes on Selecting and Assessing the Pulmonary Rehabilitation Candidate

Chapter 2: Selecting and Assessing the Pulmonary Rehabilitation Candidate

Objectives

The objectives of this chapter include:

  1. Defining the Pulmonary Rehabilitation Candidate

  2. Developing a Comprehensive Program: Tailoring a program based on the needs of pulmonary rehabilitation (PR) patients.

  3. Identifying Necessary Assessments: Determining assessments required for PR patients.

The Pulmonary Rehabilitation Candidate

The initial step in a pulmonary rehabilitation program is assessing patients through an interdisciplinary team. The key components of pulmonary rehabilitation include:

  • Self-management Education

  • Exercise Training

  • Psychosocial Interventions
    Individualized assessment is critical and is supervised by the medical director alongside the program coordinator.

Patient Selection Considerations

While pulmonary function tests like Forced Expiratory Volume in one second (FEV_1) provide useful information, they are insufficient as standalone selection criteria. Patients typically pursue therapy due to:

  • Distressing Symptoms: e.g., chronic cough, mucus production

  • Decreased Exercise Tolerance: Finding it hard to maintain physical activity

  • Difficulty Performing Daily Activities: Such as walking, bathing, etc.

  • Decreased Sense of Well-being: Overall quality of life may diminish due to respiratory issues.

Conditions Appropriate for Pulmonary Rehabilitation

Examples of both obstructive and restrictive diseases that are suitable for pulmonary rehabilitation include:

Obstructive Diseases

  1. Chronic Obstructive Pulmonary Disease (COPD)

  2. Persistent Asthma

  3. Bronchiectasis

  4. Cystic Fibrosis

  5. Bronchiolitis Obliterans

  6. Lung Cancer

  7. Pulmonary Hypertension

Restrictive Diseases

  1. Interstitial Lung Disease (ILD)

  2. Sarcoidosis

  3. Kyphoscoliosis

  4. Post-tuberculosis Syndrome

  5. Acute Respiratory Distress Syndrome (ARDS)

Assessment of Patient History

The assessment process should begin with a thorough evaluation of:

  • Respiratory History

  • Comorbidities

  • Family History of Respiratory Disease

  • Medication Use

  • Smoking History

  • Social Support Systems

  • Occupational and Environmental Exposures: Including recreational activities that could impact the respiratory system.

Physical Assessment Items

Key components of the physical assessment include:

  • Vital Signs Measurement: Blood pressure, pulse, respiratory rate

  • Arterial Oxygen Saturation: To evaluate respiration quality at rest and during activity

  • Breathing Patterns: Observing for the use of accessory muscles

  • Chest Examination: Considering inspection, palpation, percussion, and auscultation for breath sounds

  • Cardiac Examination: Observing heart rate and rhythm for any irregularities.

Diagnostic Tests

Diagnostic evaluations contribute to understanding the severity of the patient's condition. These include:

  • Spirometry: Measures lung function, focusing on FEV_1 and FVC

  • Walking Tests: Such as the 6-minute walk test

  • Chest Radiographs

  • Electrocardiograms and CBC: To assess additional health factors impacting rehabilitation potential.

Symptom Assessment

Common symptoms to assess include:

  • Dyspnea (difficulty breathing)

  • Cough and Sputum Production

  • Wheezing and Chest Discomfort: Investigating for potential underlying conditions.

Psychosocial Assessment

Consideration of patients' mental health and psychosocial factors is essential. Areas to include are:

  • Anxiety and Depression Levels

  • Motivation for Participation

  • Coping Mechanisms

  • Social Support Availability

Rehabilitation Goals

Goals of pulmonary rehabilitation typically aim to improve:

  1. Breathing Ease

  2. Activity Levels: Including daily living activities.

  3. Quality of Life Enhancements: Such as decreased anxiety or fewer exacerbations.

Potential for Rehabilitation Assessment

After conducting a comprehensive assessment, rehabilitation potential is classified into categories such as poor, fair, good, and excellent. This categorization helps in devising personalized rehabilitation plans based on specific patient needs and capabilities.

Summary

Selecting the right candidate for pulmonary rehabilitation requires a thorough understanding of the patient's history, current condition, and potential for improvement. Through comprehensive assessment criteria, healthcare providers can effectively identify suitable candidates and tailor rehabilitation programs accordingly.