Chapter. 7&8 Flashcards
What are two broad areas of outcome analysis in pulmonary rehabilitation?
patient-centered clinical outcomes & program performance measures.
What are the three essential areas of patient-centered outcomes?
functional status/exercise capacity dyspnea
health-related quality of life (health status)
What is the certification process of AACVPR mandates that a program utilize outcome data to evaluate its effectiveness?
depends on a one-on-one clinical assessment, aided by standardized tests.
The overall effectiveness of the program is best assessed using outcome assessment tools.
The certification process of AACVPR mandates that the program utilize outcome data to evaluate its effectiveness.
What are the three instruments required to identify that the AACVPR used in programs seeking certification?
modified Medical Research Council (MMRC) scale
University of California, San Diego Shortness of Breath Questionnaire
Baseline Dyspnea Index (BDI)
Transition Dyspnea Index (TDI).
Describe each of the AACVPR three program certification?
The Modified Medical Research Council (mMRC) Dyspnea Scale is a 5-point scale that assesses the level of dyspnea experienced by the patient during daily activities. It ranges from 0 (no dyspnea) to 4 (too dyspneic to leave the house or breathless when dressing or undressing).
o The University of California, San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) is a self- administered questionnaire that evaluates the impact of dyspnea on daily activities. The questionnaire includes 24 items that assess the frequency and severity of dyspnea during various activities.
o The Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) are two separate tools used to evaluate the severity and impact of dyspnea. The BDI is a baseline assessment that uses a modified Borg scale to assess the level of dyspnea during various activities, while the TDI is a follow-up assessment that evaluates the change in dyspnea from baseline to completion of pulmonary
rehabilitation program.
The TDI assesses the same activities as the BDI and uses a 7-point scale to assess changes in dyspnea severity.
What are the minimum two time points of outcome assessment in pulmonary rehabilitation?
beginning of the program and at the end of the program.
These assessments are used to evaluate the effectiveness of the pulmonary rehabilitation program and determine any changes in the patient’s functional status, dyspnea, and health-related quality of life. Additional assessments may be conducted at intermediate time points during the program to track progress and adjust interventions as necessary.
Can you identify functional status/exercise capacity and examples of how it is quantified as a common outcome measure of pulmonary rehabilitation: 6 minute walk test?
Functional status/exercise capacity is a key outcome measure in pulmonary rehabilitation programs, as it reflects the patient’s ability to perform activities of daily living and engage in physical activity.
One common way to quantify exercise capacity is through the 6 minute walk test (6MWT), which measures the distance a patient can walk in 6 minutes. The 6MWT is easy to administer and has been shown to be a reliable and valid measure of exercise capacity in patients with pulmonary disease. Patients are asked to walk as far as possible along a straight, level corridor in 6 minutes, and the distance covered is
recorded. The 6MWT is often used as a baseline measure at the beginning of a pulmonary rehabilitation program and then repeated at the end of the program to evaluate changes in exercise capacity.
How are symptoms of dyspnea and fatigue measured as common outcome measures of pulmonary rehabilitation: mMRC, COPD CAT?
Dyspnea and fatigue are common symptoms experienced by patients with pulmonary disease, and they can significantly impact the patient’s quality of life. Two common tools used to measure dyspnea and fatigue as outcome measures of pulmonary rehabilitation are the Modified Medical Research Council (mMRC) Dyspnea Scale and the COPD Assessment Test (CAT).
The mMRC Dyspnea Scale is a simple, 5-point scale that asks patients to rate their level of breathlessness during everyday activities. Scores range from 0 (no breathlessness except with strenuous exercise) to 4 (too breathless to leave the house or breathless when dressing or undressing). The mMRC is a widely used measure of dyspnea in patients with chronic obstructive pulmonary disease (COPD) and has been shown to be a reliable and valid measure.
o The COPD Assessment Test (CAT) is a questionnaire that measures the impact of COPD symptoms on the patient’s overall health status. The CAT includes eight items that assess cough, sputum production, chest tightness, breathlessness, activity limitation, confidence in leaving home, sleep, and energy levels. Each item is scored on a scale of 0-5, with higher scores indicating greater symptom severity. The CAT is a validated and reliable measure of health status in patients with COPD and is often used in pulmonary rehabilitation programs to assess changes in symptom severity over time.
How is quality of life measured using the HRQL as a common outcome measures of pulmonary rehabilitation?
Health-related quality of life (HRQL) is an important outcome measure in pulmonary rehabilitation programs because it reflects the patient’s overall sense of physical, psychological, and social well-being. The most commonly used tool for measuring HRQL in patients with pulmonary disease is the St. George’s Respiratory Questionnaire (SGRQ), which is a disease-specific measure of health status.
What is another generic measure of HRQL?
SGRQ is a self-administered questionnaire that asks patients to rate their health status over the previous month in three domains: symptoms, activity, and impact on daily life. The questionnaire consists of 50 items, and responses are scored on a scale of 0-100, with higher scores indicating greater impairment. The SGRQ has been shown to be a reliable and valid measure of HRQL in patients with chronic obstructive pulmonary disease (COPD) and other respiratory conditions.
o In addition to the SGRQ, other generic measures of HRQL, such as the Short Form-36 (SF-36), may also be used in pulmonary rehabilitation programs to assess changes in overall health status over time. The SF-36 is a widely used generic measure of HRQL that assesses eight domains of health status, including physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health.
What are minimum outcome assessments that include: exercise capacity, dyspnea and health status, and psychological (Eg, with PRIME- MD)?
Exercise Capacity: The 6-minute walk test (6MWT) is a quick and simple way to assess exercise capacity. It can be performed in less than 10 minutes and provides valuable information about a patient’s functional status and ability to perform activities of daily living.
Dyspnea and Health Status: The modified Medical Research Council (mMRC) dyspnea scale or the COPD Assessment Test (CAT) can be used to assess dyspnea and health status. These tools can be completed quickly and easily by patients and provide important information about their symptoms and overall health status.
Psychological Assessment: The PRIME-MD (Primary Care Evaluation of Mental Disorders) questionnaire can be used to assess psychological status. This tool is a brief self-report questionnaire that can be completed in 5-10 minutes and assesses common mental disorders, such as depression and anxiety. It is an important assessment to ensure that psychological factors are addressed in the pulmonary rehabilitation program.
What are measures of dyspnea?
Modified Medical Research Council (mMRC) dyspnea scale: A simple and widely used questionnaire that assesses the severity of dyspnea and its impact on daily activities.
Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI): These questionnaires are used to assess the degree of dyspnea and the patient’s response to treatment over time.
o University of California San Diego Shortness of Breath Questionnaire (SOBQ): This questionnaire assesses the intensity of dyspnea, the frequency and duration of dyspnea episodes, and the impact of dyspnea on physical and social activities.
Visual Analog Scale (VAS): This is a subjective measure of dyspnea severity in which patients rate their level of dyspnea on a scale from 0 to 10, with 0 indicating no dyspnea and 10 indicating the worst dyspnea imaginable.
Borg Dyspnea Scale: This scale is used to assess the level of dyspnea during exercise. It ranges from 0 (no dyspnea) to 10 (maximum dyspnea).
What are measures of HRQL?
St. George’s Respiratory Questionnaire (SGRQ): This is a widely used questionnaire to assess the impact of respiratory disease on HRQL. It assesses the physical, social, and psychological aspects of health status.
Chronic Respiratory Questionnaire (CRQ): This questionnaire assesses HRQL in patients with chronic respiratory disease. It includes domains such as dyspnea, fatigue, emotional function, and mastery.
COPD Assessment Test (CAT): This is a simple and quick questionnaire that assesses the impact of COPD on HRQL. It includes eight domains: cough, phlegm, chest tightness, breathlessness, activity limitation, confidence, sleep, and energy.
How is individualized, disease-appropriate approach to pulmonary rehabilitation geared to achievement of realistic goals remains necessary for all patients?
While the basic principles of pulmonary rehabilitation, such as exercise training, education, and psychosocial support, may be similar across different disease states, the specifics of the program may need to be tailored to the individual patient’s needs.
What are the appropriate exercise assessment, age-appropriate intervention and outcomes assessment for patients with asthma undergoing pulmonary rehabilitation?
study guide figure 8.2
