Pulmonary Rehabilitation

Question 1

Aims of Pulmonary Rehab

Answer 1

¬ Symptoms
¬ Participation
¬ Health care costs
¬ Optimise functional status EDUCATION + EXERCISE + SUPPORT

Question 2

Benefits of Pulmonary Rehabilitation

Answer 2

¬	 Exercise capacity
¬	 Muscle strength
¬	 Health-related quality of life
¬	 Dyspnoea level
¬	Health care utilisation benefits
¬	Psychosocial benefits
¬	Beneficial for people with other chronic respiratory diseases

Question 3

Pulmonary Rehabilitation Assessment

Answer 3

¬	Diagnosis & co-morbidities
¬	Respiratory function & smoking history
¬	Nutritional status
o	Low BMI is implicated in higher mortality for people with COPD
¬	Exercise capacity
o	Cardiovascular fitness
o	Upper limb endurance testing?
o	Muscle strength testing?
¬	Quality of Life (QOL)
¬	Dyspnoea/breathlessness
¬	Mental health assessment – anxiety and depression
¬	Patient goals

Question 4

Exercise Capacity

tests

Answer 4

¬	6MWT
¬	ISWT
¬	Cardiopulmonary Exercise test
o	Provide detailed information on physiological measurements/limitations
¬	Endurance shuttle test – ESWT
¬	Modified SWT

Question 5

Exercise Capacity Assessment

Answer 5

Use as an outcome measure:
¬ Assess level of functional impairment & limitation in activity
¬ Evaluate benefits of rehabilitation
¬ Determine the factors that limit exercise capacity
¬ Provide information that will guide exercise prescription
¬ Identify O2 desaturation during exercise and assist prescription of supplemental O2

Question 6

Quality of Life (QOL)

Answer 6

Assessment
¬ SGRQ Self-administered; lower scores = better health-related QOL
¬ CRQ Self-administered or interviewer led; higher scores = better QOL
¬ CAT Score 0 to 5 – higher score is worse

Question 7

Assessment of Breathlessness

Answer 7

¬ Modified BORG (10)

¬ RPE/BORG (20)

Question 8

Mental Health Assessment

Answer 8

¬ Anxiety & Depression Scale
o 7 Questions each related to anxiety & depression
¬ Kessler Psychological Distress Scale
o 10 Item questionnaire about anxiety & depressive symptoms
¬ Depression Anxiety Stress Scales (DASS)
o 42 Item instrument

Question 9

Upper Limb Tests

Answer 9

¬ Dyspnoea levels on ADL
¬ Incremental unsupported Upper Limb Exercise test
¬ Grocery shelving test

Question 10

Other Tests

Answer 10

¬	Muscle strength testing
o	Isokinetic (Cybex)
o	Hand-held dynamometry
o	Manual muscle tests
¬	Physical activity monitors
¬	Step test
¬	Portable Metabolic Equipment

Question 11

6MWD Prediction Equations

Answer 11

• Substantial variation in predicted values

* When FEV1 is <50% 6MWD is a better predictor of mortality