[vc_row gap=”35″][vc_column][vc_column_text]Patient assessment
A hospital or community centre baseline assessment is required to ascertain if the patient is safe to exercise at home without supervision.
This assessment includes:
Medical History
A detailed medical history, necessary to prescribe an appropriate program, includes:
- Respiratory diagnosis
- Respiratory history
- Results of relevant investigations (including CT scans, CXR’s, blood gases, ECG)
- Medications (including oxygen therapy)
- Current exercise routine
- Musculoskeletal conditions (including falls risk)
- Neurological conditions
- Continence issues
- BMI (BMI = weight (kg) ÷ height2 (m))
- Lung function
- Social / psychological issues
Results from the medical history may indicate the need for the following referrals or follow up:
- Smoking cessation
- Nutritional support
- Incontinence
- Anxiety and depression
- Airway clearance
- Treatment of musculoskeletal/neurological conditions
Exercise Capacity
Exercise capacity should be measured to ascertain a pre rehabilitation baseline and for the prescription of the exercise component of the program.
Two commonly used and validated field tests of exercise capacity for patients with chronic obstructive pulmonary disease (COPD) are:
- The Six-Minute Walk Test (6MWT)
- The Incremental Shuttle Walk Test (ISWT)
A description of how to perform these tests can be found at the Pulmonary Rehabilitation Toolkit – http://pulmonaryrehab.com.au/patient-assessment/assessing-exercise-capacity/
To evaluate the effectiveness of the program in relation to exercise capacity, the same walking test should be repeated at the completion of the program.
It is important that the walking tests are completed at the hospital or community centre where medical back up is readily available. It has also been demonstrated that, when conducted at home, the 6-minute walk test underestimates exercise capacity in chronic obstructive pulmonary disease, due to a shorter track length available in the home environment (Holland et al 2015).
Shortness of Breath
Dyspnoea severity should be assessed before and after pulmonary rehabilitation as one of the primary goals of pulmonary rehabilitation is to reduce the patient’s perception of shortness of breath.
Measurement tools available for assessing dyspnoea include:
- Modified Medical Research Council (MMRC) Dyspnoea Scale.
- Modified Borg Dyspnoea Scale (0-10).
See the Toolkit (http://pulmonaryrehab.com.au/patient-assessment/assessing-shortness-of-breath/) for a description of the features of these tools.
Some health-related quality of life measures, such as the Chronic Respiratory Disease Questionnaire, also include dyspnoea as a component.
Quality of Life
Improving quality of life is a key aim of pulmonary rehabilitation programs and is highly valued by patients. A validated measure of health-related quality of life should be included in the evaluation of a pulmonary rehabilitation program. The following questionnaires are recommended:
- Chronic Respiratory Disease Questionnaire (CRDQ or CRQ) – disease specific.
- St George’s Respiratory Questionnaire (SGRQ) – disease specific.
- Medical Outcomes Study Short Form 36 (MOS SF 36) – generic.
- COPD Assessment Test – CAT
Disease-specific questionnaires are more likely to be responsive to changes after pulmonary rehabilitation and are more sensitive to specific respiratory issues.
Generic questionnaires provide a more global view of the respiratory patient’s quality of life, include a wider range of scales and can be readily compared with other illness groups but have lower responsiveness and sensitivity.
The important features of each of these questionnaires are summarised in the Toolkit table at – http://pulmonaryrehab.com.au/patient-assessment/assessing-quality-of-life/
Psychological issues
Anxiety and depression are common issues for people with chronic respiratory disease. Prior to commencing a rehabilitation program it is recommended that patients are screened for the existence of clinically significant symptoms of anxiety and depression so that these issues can be addressed.
Assessment tools include:
- Hospital Anxiety and Depression Scale – requires a licence for use
- Anxiety and Stress Scale 21 – publicly available
- SF36
A referral to a mental health clinician should be implemented as required.
For the safety of the physiotherapist visiting the patient for the home assessment, a “Health workers Safety” check list should be completed.
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