Specialty Program: Pulmonary Conditioning
Rehab Director Steve Finn, PT leads a multi-disciplinary therapy team with a state-of-the-art therapy department and wellness center at one of our Iowa critical access hospital partners.
With a continued emphasis on what role rehabilitation can play in population health, our department focused on a patient population that has frequent hospitalizations, rehospitalizations and emergency room visits. In 2015, the physical therapy (PT) and occupational therapy (OT) teams combined with our respiratory therapy (RT) team to develop a pulmonary conditioning program to look at a myriad of chronic cardiopulmonary conditions, and specifically chronic obstructive pulmonary disease (COPD).
Our hospital RT program had previously struggled to provide an efficient and effective pulmonary conditioning program for this population. This was often due to lack of space, equipment and personnel required to allocate 45-60 minutes of one-to-one care on a two-to-three-sessions-per-week basis. Many rural hospitals likely face similar challenges.
Pulmonary rehab is a standard program at larger hospitals across the nation, frequently run by PTs. At our hospital, our rehab department was well positioned to treat this population from both a staffing and skill set perspective.
We held several meetings with RT, our medical staff director and a consulting cardiologist to prepare the policies, procedures and guidelines needed to implement the pulmonary rehab program. The final program had many pulmonary rehab principles embedded in each treatment session; aerobic training with close monitoring of vitals to include blood pressure, heart rate, O2 saturation, with titrating of O2 to meet the patient’s needs in any given task. Also included are many more traditional PT exercises to include upper extremity, lower extremity and core strengthening to maximize patient’s activities of daily living. And finally, static and dynamic balance exercises as many of these patients are at moderate or high risk for falls. Secondarily, we often identify a number of orthopedic problems, such as knee pain, and incorporate treatment for these conditions to maximize each patient’s recovery.
As we enter our fourth year of offering this specialty program for patients with cardiopulmonary conditions, we reflect on all of our successes. For most chronic health problems, success is dependent upon behavior change, and this is a challenge for all of us.
Patients have ranged from those with mild/moderate COPD to those preparing for a bilateral lung transplant to patients at end stage who are working to qualify for placement on the lung transplant list. Some of our most prominent successes have been a number of patients within the past 18 months who were on oxygen (1 to 2 liters) for their daily activities. After participating in our rehab program they no longer required the additional oxygen.
The most important avenue for success is taking an extensive amount of time during the very first session to explain how disciplined patients must be to achieve success. It’s important to explain in detail what that means, i.e. attending PT 2-3/week for 12 weeks, consistent HEP, behavior change, (i.e. they have had to have stopped smoking). Then having them decide if they are ready for such a commitment. If they are not, we inform their medical provider and leave them on that note, “if you have a change in heart and are ready to make a change in your health, then give us a call.” This eliminates us setting up a patient with visits on 2-3/week basis and going down the path of multiple no-shows and cancellations.
Rehab therapy has a tremendous skill set to offer chronic cardiopulmonary patient populations. The formal implementation of this program is possible anywhere using the established protocols developed by RehabVisions and has the potential to impact the health of your entire community.