by scott cerreta , bs, rrt director of education copdfoundation
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Expectations after Pulmonary Rehabilitation. by Scott Cerreta , BS, RRT Director of Education www.copdfoundation.org. Conflict of Interest. - PowerPoint PPT PresentationTRANSCRIPT
by Scott Cerreta, BS, RRTDirector of Education
www.copdfoundation.org
Expectations after Pulmonary Rehabilitation
Conflict of Interest
• I have no real or perceived conflict of interest that relates to this presentation. Any use of brand names is not in any way meant to be an endorsement of a specific product, but to merely illustrate a point of emphasis.
Objectives
1. Discuss current literature and outcomes after pulmonary rehabilitation.
2. Identify key elements that must be maintained after pulmonary rehabilitation.
3. Learn about the COPDF Pulmonary Education Program (PEP) as a post-graduation program.
4. Understand circumstances that lead to post-graduation loss of benefits gained during rehab.
Literature Review
• Long term effectiveness (>2years) of Pulmonary Rehabilitation is disappointing
• Drop-off is multifactoral • Two most significant factors
1. Exacerbations of COPD18
2. Decrease in adherence to exercise prescription18
• AACP/AACVPR Pulm Rehab Clinical Practice Guidelines suggests that PRCs include strategies to promote long-term adherence1
Literature Review• MT group had improved ESWT• No influence on QoL or hospital admissions
Ringbaek T, Brondum E, Martinez G, et al. Long-term effects of 1-year mainenance training on physical functioning and health status in patients with COPD. JCRPJournal; 47-52.
Maintaining Benefits after Rehabilitation1. Encourage participation in Phase III rehab– Unproven health advantages long term for:
• Continuous PR• Maintenance PR programs• Repeated courses of PR
– Cost prohibitive in current health care system2. Prevent Hospitalizations– Recognition of early signs of infection
3. Continue exercises at home or gym4. Teach Optimal Care
Optimal Care Includes:
1. Smoking cessation2. Pulmonary rehabilitation– Exercise and nutrition– Recognize early signs of infection– Breathing techniques– Coping skills– End-of-Life care
3. Annual spirometry on a good day4. Testing for Alpha-1 Antitrypsin Deficiency 5. Medication adherence
FEV1 / FVC < 70%I: MildFEV1>80% pred
II:ModerateFEV1 50-80% pred
III: SevereFEV1 30-50% pred
IV: Very SevereFEV1 < 30% pred or FEV1 <50% predicted plus respiratory failure
Active Reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator when needed
Add regular treatment with one or more long-acting bronchodilators: ß2 agonists and anticholinergicsAdd rehabilitation
Add ICS for repeated exacerbations
Add LTOTSurgical interventions
GOLD Standards of COPD Care
http://www.goldcopd.org/
The Problem with Rehab ???
• No one remembers to order it !
• Recommended for GOLD Stage II
• Only 16% of physicians send patients to Rehab
• Rehab is your key resource to improve patient adherence and understanding of this disease
Maintaining Benefits after Rehabilitation• Optimal Care must be maintained
lifelong• Encourage participation in Phase III• Find other programs and resources
to offer your patients after graduation– Develop local programs for transitional
care– Collaborate with other organizations• Local home care companies, not DME• State Smokers’ Quit Line • COPD Foundation
New Programs for the COPD Foundation1. Healthy Interactions Conversation Map– Designed for acute care / transitional care
setting – Education to decrease hospitalization and
teach patient self-management
2. Pulmonary Education Program (PEP)– Designed for pulmonary rehabilitation centers– Prolong benefits of rehab by connecting
patients to COPD Foundation resources after graduation.
Healthy Interactions Conversation Map®
• Pulmonary education not rehab– Designed for acute care admission for COPD
patient– Hospital to Home transitional care program– Small group participation 6-10– Facilitator navigates patients through a
conversation map educational tool.• Patient makes own decisions• Patient learns from others experiences• Patient learns to self-manage and become active in
care– We are still recruiting partner sites!– Final Map tool used for Rehab
Recruitment– Future role-out to clinics, hosp, home
care, etc.
All tools developed by Healthy Interactions. Conversation Map® is a registered trademark of Healthy Interactions, Inc.
Pulmonary Education Program (PEP)• Designed for Pulm
Rehab– Promotes long-term
benefits after rehab• Sit and Be Fit Exercise
DVD
• Access to COPDF Resources
• Access to COPD Info Line
• Follow-up Program with Rehab Center
• Enhance Patient Support Groups
• Host COPD Education Day events
C.O.P.D. Information Line1-866-316-COPD (2673)
• Provides empathy and support to callers, as well as access to resources (e.g. educational materials)
• Info Line associates are people with COPD
• New branch staffed by associates offer support and information for caregivers
www.copdfoundation.org
Additional COPD Resources atYour Lung Health
http://www.yourlunghealth.org/lung_disease/copd/resources/index.cfm
COPD Research Registry• Aims to build the proper cohort
of patients to enroll in clinical trials and studies
• Over 2,600 patients enrolled
• Online/paper enrollment forms
• Info available through Info Line
• Created to help increase enrollment in COPDGene Study
• National Jewish Health is data coordinating center
www.copdfoundation.org
BFRG Ver2.0
• Modeled after the Alphanet BFRG for Alpha-1
• Most comprehensive guide on COPD health management
• Over 70 individuals and organizations contributed
www.copdbfrg.org www.copdfoundation.org
SSRGs1. Coping with COPD
2. End-of-Life
3. Exacerbations
4. Exercise
5. Medicine
6. Nutrition
7. Oxygen Therapy
8. Travel
9. Understanding Lung Disease
10. Understanding Testswww.copdfoundation.org
Summary
• Teach optimal care• Keep patients involved with lifelong
care• Know your patients – What stage
COPD– Encourage spirometry annually– Encourage patients learn their FEV1 and
stage• Collaborate with others to maintain
long term benefits of pulmonary rehabilitation
• End result is decreased hospitalizations and improved patient outcomes.
Thank You!
References1. Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR evidence based
clinical practice guidelines. Chest 2007;131;4S-42S2. Ries AL, Make BJ, Lee SM, et al. The effects of pulmonary rehabilitation in the National Emphysema
Treatment Trial. Chest 2005; 128:3799–38093. Cambach W, Wagenaar RC, Koelman TW, et al. The long-term effects of pulmonary rehabilitation in
patients with asthma and chronic obstructive disease: a research synthesis. Arch Phys Med Rehabil 1999; 80:103–111
4. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000; 355:362–368
5. Troosters T, Gosselink R, Decramer M. Short- and longterm effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med 2000; 109:207–212
6. Foglio K, Bianchi L, Ambrosino N. Is it really useful to repeat outpatient pulmonary rehabilitation programs in patients with chronic airway obstruction? A 2-year controlled study. Chest 2001; 119:1696–1704
7. Finnerty JP, Keeping I, Bullough I, et al. The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest 2001; 119:1705– 1710
8. Ries AL, Kaplan RM, Myers R, et al. Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial. Am J Respir Crit Care Med 2003; 167:880–888
9. Guell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest 2000; 117:976–983
10. Griffiths TL, Phillips CJ, Davies S, et al. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax 2001; 56:779–784
References11. Wijkstra PJ, van der Mark TW, Kraan J, et al. Long-term effects of home rehabilitation on physical
performance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 153:1234–124
12. Engstrom CP, Persson LO, Larsson S, et al. Long-term effects of a pulmonary rehabilitation programme in outpatients with chronic obstructive pulmonary disease: a randomized controlled study. Scand J Rehabil Med 1999; 31:207–213
13. Wijkstra PJ, TenVergert EM, van Altena R, et al. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax 1995; 50:824–828
14. Berry MJ, Rejeski WJ, Adair NE, et al. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 2003; 23:60–68
15. Puente-Maestu L, Sanz ML, Sanz P, et al. Long-term effects of a maintenance program after supervised or self-monitored training programs in patients with COPD. Lung 2003; 181:67–78
16. Grosbois J-M, Lamblin C, Lemaire B, et al. Long-term benefits of exercise maintenance after outpatient rehabilitation program in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 1999; 19:216–225
17. Cockram J, Cecins N, Jenkins S. Maintaining exercise capacity and quality of life following pulmonary rehabilitation. Respirology 2006; 11:98–104
18. Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS. The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. Eur Respir J 2002; 20: 20–29.
19. Ringbaek T, Brondum E, Martinez G, et al. Long-term effects of 1-year mainenance training on physical functioning and health status in patients with COPD. JCRPJournal; 47-52.
20. COPD Foundation. www.copdfoundation.org