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. 2020 Feb 5;17(3):1016.
doi: 10.3390/ijerph17031016.

Therapist Driven Rehabilitation Protocol for Patients with Chronic Heart and Lung Diseases: A Real-Life Study

Carla Simonelli  1 , Michele Vitacca  2 , Nicolino Ambrosino  3 , Simonetta Scalvini  1 , Francesca Rivadossi  1 , Manuela Saleri  2 , Aubin G Fokom  2 , Ilaria Speltoni  1 , Riccardo Ghirardi  2 , Mara Paneroni  2
Affiliations

Therapist Driven Rehabilitation Protocol for Patients with Chronic Heart and Lung Diseases: A Real-Life Study

Carla Simonelli et al. Int J Environ Res Public Health. .

Abstract

Therapist driven protocols may help to tailor rehabilitation programs to individual patients. We aimed to test the feasibility, safety, and clinical usefulness of a therapist driven protocol for rehabilitation including exercise training of patients with heart or lung diseases. An internal audit elaborated the Cardio-Respiratory Exercise Maugeri Algorithm (CREMA) based on: (a) standardized baseline assessments, (b) decision-making pathways, and (c) frequency/intensity/time/type (FITT) of prescription for each exercise. Outpatients (n = 620) with chronic heart disease (CHD), recent myocardial revascularization (REVASC), chronic airway (Obstructive), and restrictive lung (Restrictive) diseases underwent exercise training according to CREMA during 4 years. Peripheral muscle strengthening was the most prescribed exercise (83.6%), while arm endurance training was the least frequently (0.75%). Exercise prescription varied widely among the disease groups (interval training 19-47%, balance 35-49%, lower limb muscle training 6-15%). After training, REVASC patients were the best improvers in the 6 min walking distance (+48.7 (56.1) m), maximal inspiratory pressure (+9.6 (15.4) cmH2O), and daily steps (+1087.2 (3297.1) n/day). Quadriceps and biceps strength, maximal expiratory pressure, and balance improved in all groups, without significant differences. Minor side effects were observed in 11.2% of the patients. The CREMA therapist driven protocol was feasible, safe, and useful for prescribing tailored training programs. Exercise prescriptions and training response differed among diseases.

Keywords: algorithm; cardiac rehabilitation; exercise; physiotherapist protocol, driven protocols; pulmonary rehabilitation; training.

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Conflict of interest statement

The Authors have no conflict of interest to disclose related to the manuscript.

Figures

Figure 1
Figure 1
The algorithm developed in the audit process and used as a guide to train subjects with heart and lung diseases. 6MWD: 6-min Walk Distance; MEP: Maximal Expiratory Pressure; MIP: Maximal Inspiratory Pressure.
Figure 2
Figure 2
Flow diagram of the study.
See this image and copyright information in PMC

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