CARDIAC
REHABILITATION
The WHO defines cardiac
rehabilitation as:
The rehabilitation of cardiac patients is the sum of activities required to influence favourably the underlying
cause of the disease, as well as the best possible physical, mental and
social conditions, so that they may, by their own efforts, preserve
or resume when lost, as normal a place as possible in the community.
Rehabilitation cannot be regarded as an isolated form of therapy,
but must be integrated with the whole treatment, of which it forms only
one facet.
(WHO 1993)
Cardiac rehabilitation is a comprehensive intervention that offers
education, exercise and psychosocial support for patients with CHD and their
families and is delivered by many specialist health professionals. Cardiac
rehabilitation can promote recovery, enable patients to achieve and maintain
better health, and reduce the risk of death in people who have heart disease.
COMPONENTS OF CARDIAC REHABILITATION
·
Risk factor assessment and
modification.
·
Education.
·
Exercise.
·
Psychosocial support.
Operation and delivery
It
transpires that cardiac rehabilitation is really a continuum of care from the
time the patient is admitted until discharge and extends to outpatient care, as
well as longterm follow-up in the community. Patient care is shared with the
cardiology team, of which cardiac rehabilitation forms an essential part.
Cardiology management includes patient assessment and risk stratification
(predicting the likelihood of recurrence of cardiac events and disease prognosis).
The patient also undergoes diagnostic tests and drug therapy, and may need
revascularisation, such as angioplasty or a bypass grafting as appropriate. Traditionally,
cardiac rehabilitation is divided into four phases, progressing from the acute
hospital admission stage to long-term maintenance of lifestyle change.
Phase
I: inpatient period.
Phase
II: early post-discharge period.
Phase
III: supervised outpatient programme, including structured exercise.
Phase
IV: long-term follow-up/maintenance in primary care.
Phase
I: Inpatient period
Cardiac
rehabilitation is offered as soon as it is practical as an integral part of
care to someone who is admitted (or who is planned to be admitted) to hospital
with CHD.
It
includes:
·
assessment of physical,
psychological and social needs;
·
negotiation of a written
informal plan for meeting these identified needs;
·
initial advice on lifestyle,
e.g. smoking cessation, physical activity (including sexual activity), diet, alcohol
consumption and employment;
·
mobilisation;
·
education about prescribed
medication, its benefitsand possible side effects;
·
involvement of relevant
informal carer;
·
provision of locally written
information about cardiac rehabilitation;
·
discharge planning.
Phase
II: Early post-discharge period
This
service shows variation in different regions and can vary from as little as a
telephone helpline to group sessions or individual appointments The National
Service Framework recommendation includes:
·
comprehensive assessment of
cardiac risk, including physical, psychological and social needs for cardiac rehabilitation,
and a review of the initial plan to meet these needs;
·
provision of lifestyle
advice and psychological interventions according to the agreed plan by the multi-disciplinary
team;
·
maintaining involvement of
relevant informal carer;
·
home visits, if appropriate.
Phase
III: Supervised outpatient programme, including structured exercise
Traditionally,
this phase is well set up in the form of an outpatient hospital-based
programme, although more services are now shifted into primary care. It
includes:
·
risk stratification and
identification of the high-, medium- and low-risk patient for exercise;
·
individualised progressive
exercise prescription and supervised exercise sessions which vary from 4–12 weeks
in different regions;
·
re-evaluation of risk
factors for CHD and health promotion advice and education
·
psychosocial interventions,
such as stress management, counselling and vocational guidance.
Phase
IV: Long-term follow-up/maintenance in primary care
This phase is now well set up in many districts, with emphasis on
provision of exercise sessions available in community or leisure centres.
Specialist training to exercise CHD patients in the community is available to
the exercise instructors by the British Association for Cardiovascular Prevention
and Rehabilitation (BACPR).
Phase
IV includes:
·
long-term maintenance of
individual goals;
·
professional monitoring of
clinical status and follow-up of general progress;
·
ongoing psychosocial support
and support groups.
Cardiac
rehabilitation team
The cardiac rehabilitation package individualised for each patient
requires expertise and skills from a multidisciplinary collaborative team of
professionals The team includes a cardiologist and staff from nursing,
physiotherapy, dietetics, pharmacy, occupational therapy and psychology with
training in cardiac rehabilitation. Continuation of care in the community
involves the primary healthcare team that is the general practitioner and
cardiac nurse, phase IV exercise specialist and a link from a local cardiac
patient support group
The
role of the physiotherapist
Physiotherapists have the knowledge, assessment skills and
clinical reasoning, combined with evidence-based approach to treatment, to
undertake the rehabilitation management of patients with multi-pathology
problems. Physiotherapists are also trained to run group sessions and classes.
Hence, the role of the physiotherapist within the multi-disciplinary
team should focus on exercise prescription, training
and education in phases I–III. The modification in
exercise prescription needs to be discussed with medical
and nursing team members. In a group setting where
exercise is delivered to CHD patients, teamwork and
liaison with other team members who are aware of patients’
clinical and psychosocial issues is essential.
Reference:
·
Tidys Physiotherapy, (15th)
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