PULMONARY REHABILITATION
PULMONARY REHABILITATION IS A
MULTIDISCIPLINARY TEAM APPROACH
CHARISA ANTONETTE S. HUELVA
August 31, 2021
I. PULMONARY REHABILITATION:
MULTIDISCIPLINARY APPROACH
• Clinicians from a variety of health care disciplines should be
present.
• Each members have special interest or training.
• Team conferences
A. TEAM MEMBERS
• Pulmonary Physician
o Program medical director
o Initial screening of patients
o Represents the program to hospital administration,
medical staff colleagues, and community
o Initiate, review, participate in, and evaluate pulmonary
rehabilitation research
• Program Coordinator
o An RT, RN, or PT
o May serve in combined roles as program coordinator
and primary patient caregiver
▪ Implements daily program activities
▪ Maintains written and verbal communication with
each patient’s referring physician
▪ Participates in the development and
implementation of program marketing plan
▪ Develops and revises program policies and
procedures
▪ Collects and reports program quality assurance
data
▪ Reviews current pulmonary rehabilitation literature
and updates protocols and equipment as indicated
▪ Represents the program to the other hospital
departments and to the community.
▪ Provides patient education on select topics
▪ Performs assistance as needed with ADLs
▪ May participate in exercise testing
• Dietitian
o Evaluates nutritional status of patients
o Recommends individual dietary modifications, including
calories, components, and supplements as indicated
o Instructs patient and family on diet
o Develops individualized sample menu
• Social Worker
• Psychologist/Psychiatrist
o Consultant basis
o Recommends or prescribes psychotropic medications
• Pharmacist
• Clergyman
• Occupational Therapist
o Evaluates the impact of COPD on the patient’s ability to
perform ADL as well as home maintenance, social, and
vocational activities
o Includes instruction on:
▪ Coordinated breathing strategies
▪ Energy conservation
▪ Work simplification techniques
• Physical Therapist
o Teaches relaxation and biofeedback techniques
o May design warm-up, strengthening, and toning
exercises
o Consultation, treatment, and modified exercise
recommendations for pulmonary rehabilitation patients
with specific neuromusculoskeletal conditions
II. PROGRAM DESIGN
• Format
• Content
• Physical Reconditioning
• Educational Component
• Psychosocial & behavioral component
A. FORMAT
• Open-ended format
o Patients enter the program and progress through it until
they achieve certain predetermined objectives
o No set time frame
o Depends on his/her condition, needs, motivations and
performance
o Good for self-directed patients or patients with
scheduling difficulties
o Best format for patients requiring individual attention
o Drawback: lack of group support or involvement
• Closed design
o Set time period to cover program content
o Usually runs 6-16 weeks; 1-3 times weekly
o Sessions last up to 2 hours
o Presentations are formal, group support and
involvement is encouraged
o Drawback: schedule determines program completion
rather than objectives
B. CONTENT
• Usually combines physical reconditioning with education
activities
• Ideal rehabilitation session should last about 2 hours
• Group size, available equipment, and group interaction
dictate session length
• Patients should arrive 10-15 minutes before a scheduled
session to allow for informal group interaction and support
• Educational presentations should be brief and to the point
• Audio-Visual Presentations (AVPs) or actual demonstration
to enhance understanding
• Language should be simple, and unnecessary technical
terms or concepts should be avoided
• Handouts that enhance certain points made during a
presentation are both useful and desirable
• Folder or notebook in which program activities may be
recorded and handout materials kept should maintained by
each patient
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C. PHYSICAL RECONDITIONING
• Consist primarily of an exercise prescription with target heart
rate based on the results of the patient’s initial exercise
evaluation
• Initial target heart rate is set using Karvonen’s Formula
o Target HR = [(MHR-RHR)*(50%-70%)] + RHR
• 4 related components of exercise prescription:
o Lower extremity aerobic exercises
o Timed walking (6 or 12-minute walking)
o Upper extremity aerobic exercises
o Ventilatory muscle training
• To ensure success, patient must actively participate both at
the rehabilitation facility and at home
• Should be upbeat; lively music helps to maintain a positive
atmosphere
• To ensure compliance with the program, a daily log or daily
sheet is completed
D. EDUCATIONAL COMPONENT
• Covers topics that are both useful and necessary to the
patient
• Recommendations regarding the best facilitators for each
session are included
• Topics should be presented in an orderly, coherent fashion
using AVP and demonstration
• Program facilitator or leader must ensure that sessions begin
on time and encourage maximum participation by each
participant
• Health care professionals should be invited to present their
respective topics and discuss the subject matter with the
group
• Session leaders should possess group facilitation skills
• Respiratory Structure, Function, and Pathology, Including a
Discussion of Dyspnea
o This presentation lays the groundwork for the program
and gives each patient some basic information about
the cardio-respiratory system and related disorders
o Causes of shortness of breath are presented
• Breathing Control Methods
o Serves as cornerstones for the physical reconditioning
effort
o Patients must learn how to control their breathing efforts
to ensure maximum result (ventilation) at a minimum
effort (energy expenditure)
o Diaphragmatic breathing and purse lips
• Methods of Relaxation & Stress Management
o Patients must learn how to avoid aggravation and
upsetting circumstances and to adopt a more relaxed
attitude about their life circumstances
o This attitude can help to reduce unnecessary oxygen
use, conserve energy and avoid undesirable
cardiovascular and nervous responses to stress.
• Exercise Techniques and Personal Routines
o Rationale for and value of exercise should be discussed
with suggestions for the adoption of personal exercise
routines after the rehabilitation program is over
• Secretion Clearance & Bronchial Hygiene Techniques
o Especially helpful to patients who have secretion
clearance problems associated with chronic bronchitis
and bronchiectasis
o Family members and friends may be invited to attend
this session to acquire basic skills with these
procedures
• Home Oxygen and Aerosol Therapy
o An RT with home care experience should provide this
session
o Focus should be on the care and use of home care
equipment and self-administration of therapy
o Presenting the modalities available and having patients
discuss their positive experiences with respiratory home
care personnel can help alleviate the fears and
anxieties of others
• Medications
o Content should emphasize proper use of medications
along with possible abuses and adverse effects
o Leader should demo proper use of MDI including
spacers or holding chambers, dry powder inhalers, and
hand help nebulizers
o Sufficient time should be provided for Q&A
o 2 sessions should be allotted for this topic
• Dietary Guidelines
o Focuses on weight management and good nutrition as
it relates to cardiopulmonary healthy
o Emphasis: sound high-CHON, low-CHO diet
o Include:
▪ Proper eating habit, methods of gaining and losing
weight, foods to avoid, ways to increase appetite
and daily menu planning
o Session can stimulate patients to eat better and supply
their bodies with the necessary fuel for increased
energy production
• Recreational & Vocational Counseling
o Session should motivate participants to participate in
recreational activities and, according to ability, return to
work
o Usually presented at the end of the program when
patients have increased their physical endurance and
are preparing for a more active and productive lifestyle
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E. PSYCHOSOCIAL AND BEHAVIORAL COMPONENTS
• Provides patients with the opportunity to learn coping
strategies
• Most useful for patient with anxiety or depression or both
• Assess psychologic status, motivation and several aspects
of quality of life in patients with chronic pulmonary diseases

F. ADDITIONAL TOOLS
• Minnesota Multiphasic Personality Inventory (MMPI)
o Assess ten major dimensions of emotional distress and
personality disturbance
• Profile of Mood States (POMS)
o List of adjectives rated on a Likert-type scale to indicate
recent mood
• Katz Adjustment Scale
o Composed of five subscales that focus on social
adjustment, recreational activities, and general
psychologic disturbance
• Sickness Impact Profile
o Measures the effect of illness on behavioral function in
12 areas of daily living such as ambulation, home
maintenance, social interaction, communication,
alertness, etc.
• Quality of Well-being Scale (QWBS)
o Indicates health-related life quality at one point in time
• Eysenck Personality Inventory
o Assess basic pertinent personality traits
• Rotter’s Locus of Control Scale
o Evaluates the extent to which an individual perceives
internal or external factors as responsible for outcomes
and events in his life.
• Additive Daily Activities Profile Test (ADAPT)
o Self-administered test
o Patient identify which of 105 activities they currently
perform and which they have stopped due to respiratory
limitations
o Activities are listed in order of descending estimated
volume of oxygen utilization requirement