Cardiopulmonary Rehabilitation and the Occupational Therapist

Addressing risks & patient education are ways to lessen the occurrences of cardiopulmonary incidences.

Cardiovascular diseases (CVDs) are the leading cause of death globally, with an estimated 17.9 million people (about the population of New York) dying from CVDs in 2019. This number represents 32% of all global deaths, with 85% caused by heart attacks and stroke.

Over 75% of CVD deaths occur in low- and middle-income countries. Most cardiovascular diseases can be prevented by addressing behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, and excessive use of alcohol. Early cardiovascular disease detection and interdisciplinary treatment improve patient outcomes.

Recommended course: Cardiopulmonary Patient Care – Rehabilitation Assessment & Interventions

Contributors to heart disease and heart failure

According to the Centers for Disease Control (CDC), millions of adults have heart failure. The highest heart disease death rates are located primarily in Mississippi, Louisiana, Arkansas, Oklahoma, Texas, Kentucky, Tennessee, Indiana, Illinois, and Wisconsin.

Risk factors for cardiovascular disease fall into two categories: non-modifiable and modifiable risks. Non-modifiable risk factors are disease contributors the person cannot control. Modifiable risk factors can be modified by the person. As a result, identifying a client’s modifiable risk factors and creating a plan to reduce those risks is important for decreasing the risk of heart disease.

Non-modifiable risk factors for heart disease include:

• Age
• Family history/genetics
• Existing heart disease (e.g., coronary artery disease, prior MI)

Modifiable risk factors for heart disease include:

• Cigarette smoking
• Sedentary lifestyle
• Obesity
• Hypertension
• Elevated cholesterol and lipids
• Pre-diabetes and unhealthy diet
• Stress levels

Conditions for cardiopulmonary rehabilitation

Although a preventative approach is optimal, some patients will require rehabilitation. A patient with a medical history of other medical co-morbidities, it is possible that they have already had one significant medical incident. Patients who may require cardiopulmonary rehabilitation include patients who have been diagnosed with:

• Chronic obstructive pulmonary disease (COPD)
• Persistent asthma
• Cystic fibrosis
• Interstitial fibrosis
• Sarcoidosis Chest wall diseases
• Kyphoscoliosis
• Ankylosing spondylitis
• Parkinson’s disease
• Amyotrophic lateral sclerosis
• Multiple sclerosis
• Lung cancer
• Primary pulmonary hypertension

Interdisciplinary teams

An interprofessional team can provide a comprehensive plan for addressing modifiable risks and barriers to occupational performance resulting from non-modifiable risks. Each member of the team addresses the modifiable risk factors for prevention and maintenance of health. An interdisciplinary team can include:

• Occupational therapist practitioners (OTPs)
• Physical therapists (PTs)
• Nurses
• Doctors
• Nutritionists

Benefits of interprofessional practice and interprofessional education

Interprofessional practice (IPP) and interprofessional education (IPE) are important for facilitating a complete treatment plan. The World Health Organization (WHO) says IPE occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.

WHO defines IPP as a collaborative practice that occurs when multiple health workers from different professional backgrounds work with patients, families, carers, and communities to deliver the highest quality of care across settings. IPP and IPE are best practices in all healthcare settings.

Benefits of IPP and IPE include:

• Improves client outcomes.
• Reinforces client skills by providing additional practice with multiple disciplines.
• Increases communication between disciplines.
• Increases the knowledge of multi-disciplinary teams.

Recommended course: Cardiac Conditions – Pathophysiology, Diagnostic Tests and Procedures, and Treatment

IPP and IPE implementation

IPP and IPE can be implemented in a variety of ways. Some examples include:

• Co-treating with other disciplines.
• Exchanging treatment ideas within the scope of each discipline’s practice.
• Observe treatments of other disciplines.
• Schedule treatment sessions with intention.

Assessments for occupational therapy 

Therapists can assess a client’s health via multiple measures that provide a complete picture of client’s function and wellness. The information from assessments can be used to inform care plans to address modifiable risks. Assessments do not require an excessive amount of equipment and do not have to be complicated to provide information regarding a patient’s functional abilities.

• The Six Minute Walk Test is a measure of functional fitness and measures a patient’s aerobic capacity. It is a simple assessment to administer.
• The Timed Up and Go is another simple assessment. It measures the performance of the lower extremity function, mobility, and fall risk.
• Manual Muscle Testing (MMT) can be done without additional equipment. It measures the strength of an individual muscle or muscle group against applied resistance, gravity or without gravity.
• Grip strength in adult populations can be objectively measured using a dynamometer. Multiple disciplines can use dynamometers for patient grip strength. While grip strength should not be the only means of accessing wellness, these measurements are more accessible than body systems measurements that may require a referral, special equipment, or lab work. Measuring grip strength is also relatively simple and accessible for many facilities.