1996 OPEN FORUM Abstracts
Getting the Patient Ready: The Rehabilitation Process
Trina Limberg, RRT Tuesday, November 5, 1996
Pulmonary rehabilitation has been an important treatment for ventilatory impaired patients for more than 25 years. Only recently has the subject moved to the spotlight with the development of lung volume reduction surgery. A review of the literature is mixed with some centers incorporating rehab either pre-operatively or post-operatively for varying periods ranging from 1-2 weeks to 5-6 weeks. Many centers have not included rehabilitation in the volume reduction surgical program. Fewer articles offered descriptions of what pulmonary rehabilitation included. Most focused on exercise as a singular component. Also, the role of pulmonary rehabilitation in the selection of patients has not been emphasized.
Pulmonary rehabilitation is a treatment for disability and unwanted changes in lifestyle caused by deteriorating lung function and dyspnea. Exercise is a key element to improve tolerance and endurance but should not stand alone. It should be accompanied with the other basic components of education and psychological support.
The pre-operative rehab process starts with a comprehensive assessment which helps to identify activities of daily living performance and detect possible problems with medication and oxygen therapy use. Learning about patient expectations for surgery and rehab are also essential. If the patient is motivated and meets the criteria of need, training may be initiated.
The pre-operative goals for rehab training are very similar to training for non-surgical ventilatory impaired patients. The goals for rehab should be to improve the patients understanding and use of techniques and treatments that improve function and self-care such as breathing retraining, proper use of oxygen therapy and medications. Secondly, improving exercise endurance to thirty minutes of continuous walking, although some patients with low MVVs may need to train with repeating short intervals. An arm ergometer and light free weights can be used to improve upper body strength. The pre-op rehab experience provides an opportunity for the patient to decide if surgery is still desired. Anecdotally, some patients have chosen to opt out of surgery after rehab training. Patients attribute this to improved quality of life and function.
The post-operative rehab process initially includes low level training with chair exercises and treadmill walking. Arm ergometry and stationary bikes can be included in the exercise program. Problems such as muscle weakness, fatigue, weight loss and soreness may occur. Oxygen requirements may also change and should be monitored closely. Some studies show improvements in oxygenation as far out as three months post-operatively. This should be considered when planning for post-operative exercise training. Before discharging patients from post-op rehab recommendations for a home exercise program should be implemented. Some patients will need referral back to community programs.
An important success factor to post-op training is the expertise and continuity of care provided by the rehab team. Effective communication between physicians and the rehab team is crucial.