Transcript No Slide Title

Expectations after Pulmonary
Rehabilitation
by
Scott Cerreta, BS, RRT
Director of Education
www.copdfoundation.org
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 Rehabilitation
1. 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 system
2. Prevent Hospitalizations
–
Recognition of early signs of infection
3. Continue exercises at home or gym
4. Teach Optimal Care
Optimal Care Includes:
1. Smoking cessation
2. Pulmonary rehabilitation
–
Exercise and nutrition
–
Recognize early signs of infection
–
Breathing techniques
–
Coping skills
–
End-of-Life care
3. Annual spirometry on a good day
4. Testing for Alpha-1 Antitrypsin Deficiency
5. Medication adherence
GOLD Standards of COPD Care
FEV1 / FVC < 70%
I: Mild
II:Moderate
III: Severe
FEV1>80% pred
FEV1 50-80% pred
FEV1 30-50% pred
IV: Very Severe
FEV1 < 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 anticholinergics
Add rehabilitation
Add ICS for repeated exacerbations
Add LTOT
Surgical interventions
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 Foundation
1. 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 Line
1-866-316-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 at
Your 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
www.copdfoundation.org
• National Jewish Health is data
coordinating center
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
SSRGs
1. 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 Tests
www.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.
References
1.
Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR evidence based clinical
practice guidelines. Chest 2007;131;4S-42S
2.
Ries AL, Make BJ, Lee SM, et al. The effects of pulmonary rehabilitation in the National Emphysema Treatment
Trial. Chest 2005; 128:3799–3809
3.
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
9.
randomized trial. Am J Respir Crit Care Med 2003; 167:880–888
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
References
11.
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 selfmonitored 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