Pulmonary rehabilitation can be tweaked to safely accommodate patients with heart disease and other common co-morbidities, a leading physiotherapy academic has told the conference.
The presence of co-morbidities including metabolic syndrome, muscular skeletal dysfunction, osteoporosis, chronic pain, anxiety and depression is increasingly common in patients with chronic obstructive pulmonary disease, and research has shown this group are more likely to drop out, or never start, rehabilitation, Dr Annemarie Lee from Monash University told delegates attending TSANZSRS 2018.
But research has also shown that not only can standard pulmonary rehabilitation be safely delivered to this sub-group, programmes can be tailored to individual patient’s needs to further improve their outcomes.
“When it comes to pulmonary rehabilitation, there has traditionally been a one-size-fits-all approach,” Dr Lee told the limbic in an interview.
But with most people now showing up with at least one other chronic condition, a standard exercise prescription that would just accommodate a respiratory condition is “no longer what’s done in clinical practice”.
“We need to be looking at the whole person in front of us and see them, not just as a respiratory condition,” she says.
“We need to be able to accommodate a rehab program in terms of exercise and education component to address what is most significant for them, how it fits in with their goals and the management of their overall health problems.”
The modifications will vary depending on the co-existing conditions.
For example, modifications to address pain during exercise may include the use of heat therapy, TENS (transcutaneous electrical nerve stimulation) or substituting traditional exercise for water-based activities.
Patients who are frail or have a history of falls may be offered balance training, while those with diabetes or heart disease can be educated on how their disease and risk factors coincide with exercise.
A big part of the shift must come at the start of the program, with physiotherapists considering a broader range of factors in an initial assessment such as pain and balance, cardiovascular and metabolic risk factors, frailty and goals for treatment outcomes.
Another key is the successful collaboration between physicians, GPs and the physiotherapists involved in the patient’s care.
“Then you get a much more patient-centred approach and you’re avoiding the doubling up. You don’t want a patient doing pulmonary rehab and then going off and doing cardiac rehab because they also have a cardiac condition. They should have everything integrated so they can go to one program that can address their chronic disease needs.”
Dr Lee said traditionally many physicians have appeared reluctant to refer patients with multiple chronic conditions to pulmonary rehabilitation, but this wariness is unwarranted.
“The literature says even if they do have co-morbidities they can still achieve benefit in terms of the standard rehab program and we now have ways that we can make outcomes even better.
“Unless there is a concern about their safety, they should be attending, regardless of what other conditions they have.”