Chapter 1 and 2 Flashcards
What is the definition of pulmonary rehabilitation according to the American thoracic society/european respiratory society?
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.
Can you explain or identify why there are positive effects of pulmonary rehabilitation even though pulmonary rehabilitation does not improve FEV1?
It is because pulmonary rehabilitation identifies, addresses, and treats systemic problems and comorbid conditions.
Pulmonary rehabilitation also increases exercise capacity, improves breathing techniques, provides education, and counseling, improves the quality of life, reduces symptoms, and manages patient condition more effectively.
Can you list examples of potentially reversible conditions by pulmonary rehabilitation?
-peripheral muscle dysfunction secondary to deconditioning possibly systemic inflammation.
-inactive lifestyle
-body composition abnormalities
-poor self-management skills
-anxiety and depression
What is the difference in the strength of evidence (Grade 1 or Grade 2) evidence-based pulmonary rehabilitation practice according to the American College of Chest Physicians?
Grade 1 is categorized as strong.
Grade 2 is categorized as weak.
Differentiate between strength of evidence (Grade A, B, or C) for evidence-based pulmonary rehabilitation practice according to the American College of Chest Physicians?
Grade A (high): well-designed randomized clinical trials yielding consistent and directly applicable results or from overwhelming evidence from observational studies.
Grade B (moderate): randomized clinical trials with limitations that may include methodological flaws or inconsistent results.
Grade C (low): evidence is based on expert opinion, case series, or observational studies with a high risk of bias or inconsistency.
What are all the Grade 1A recommendations for pulmonary rehabilitation?
A program of exercise training for the muscles of ambulation is recommended as a mandatory component of pulmonary rehabilitation for patients with COPD. Grade of recommendation: 1A
Pulmonary rehabilitation improves the symptom of dyspnea in patients with COPD. Grade of recommendation: 1A
Pulmonary rehabilitation improves health-related quality of life in patients with COPD. Grade of recommendation: 1A
6-12 weeks of pulmonary rehabilitation produces benefits in several outcomes that decline gradually over 12 to 18 months. Grade of recommendation: 1A
Both low- and high-intensity exercise training produce clinical benefits for patients with COPD. Grade of recommendation: 1A
The addition of a strength training component to a program of pulmonary rehabilitation increases muscle strength and muscle mass. Strength of evidence: 1A
Unsupported endurance training of the upper extremities is beneficial in patients with COPD and should be included in pulmonary rehabilitation programs. Grade of recommendation: 1A
What is the difference between a recommendation with Grade 1A as compared to a Grade 2C?
Grade 1A is a strong and well-designed randomized clinical trial yielding consistent and directly applicable results or from overwhelming evidence from observational studies.
Grade 2C is weak and the evidence is inconsistent, limited, or based on non-randomized studies or expert opinion.
Why the integration of care approach of the COPD patient is key in regard to multiple and important comorbidities?
Patients with COPD often have other health conditions that can complicate their care and treatment.
It is a concept bringing together inputs, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation, and health promotion.
Provides comprehensive care that improves outcomes and enhances the quality of life.
What is the purpose of the Global Initiative for COPD(GOLD) consensus of 2019? Does the GOLD initiative supports pulmonary rehabilitation as an established or experimental treatment for COPD?
Purpose of (GOLD): to provide updated guidance for the diagnosis, management, and prevention of COPD.
GOLD initiative supports pulmonary rehabilitation as an established treatment for COPD.
Is pulmonary rehab reimbursed by Medicare?
YES, pulmonary rehabilitation may be reimbursed by Medicare.
In 2009 Congress passed a bill making pulmonary rehabilitation Medicare-reimbursed benefits for patients with moderate to severe COPD.
How long-term benefits and self-efficacy may be promoted following pulmonary rehabilitation?
-By providing longer pulmonary rehabilitation programs.
-Reintroducing a modified form of pulmonary rehabilitation after an exacerbation.
-Incorporating and stressing structured exercise and increased activity in the home setting early in the course of pulmonary rehabilitation.
-Promoting self-management strategies that encourage the patient to be more responsible for his or her health.
Whether have been any studies that support self-management as part of COPD rehabilitation to reduce hospitalizations in COPD patients?
YES, there have been studies that support self-management as part of COPD rehabilitation to reduce hospitalization in COPD patients.
There are some studies that say that self-management helps reduce the number of hospitalizations, improved quality of life, and reduce hospital admissions, and healthcare costs.
When patient’s FEV1 is a good selection criteria for pulmonary rehabilitation?
A patient’s FEV1 is not sufficient as selection criteria because patients seek therapy due to:
-distressing symptoms
-decreased exercise tolerance
-difficulty performing activities
-or a decreased sense of well-being.
What an initial assessment should begin with a patient interview and the purpose for the interview?
The purpose for the interview: is the foundation of trust and credibility allows patients to interact on a personal level with the rehabilitation staff.
Allows patients to see where the program is located and possibly meet rehabilitation graduates.
Essential diagnostic data needed for the initial medical evaluation of the pulmonary rehabilitation candidate?
-Spirometry
-Oxygen saturation at rest and with walking
exercise upon program entry
-Chest radiograph
-Electrocardiogram
-Field test of exercise capacity, such as the
-6-minute walk test or the shuttle walk test,
upon program entry
-Screening assessment of anxiety and depression, such as the Beck Depression Inventory or the Hospital Anxiety and Depression
-Scale, upon program entry
-CBC
