Evolution of CardioPulmonary Rehabilitation in a Rural

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Evolution of Cardio-Pulmonary Rehabilitation in a
Rural Remote Setting
Nicole Freene Physiotherapist Primary
Health Robinvale District Health Services
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Robinvale District Health Services

• Multipurpose service
• Primary Health at RDHS commenced in November
  2001, funded by the Commonwealth
• Covers over 62,000 square kilometres in the
  Central Murray/Northern Mallee region
• Population of approximately 20,000
• Allied Health travel between Victoria NSW
  -Robinvale, Manangatang, Ouyen, Wentworth,
  Dareton and Balranald .

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RDHS Primary Health Care Priority Health Needs

• Cardiac and Respiratory Disease
• Address these via a group program in Robinvale
• Barriers - past travel long distances
• - future small population

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Combination of 2 diagnostic groups
Cardio-Pulmonary Rehabilitation

• Inclusion criteria
• Post cardiac intervention or event and other
  cardiovascular disease
• Chronic lung disease eg COPD, asthma
• Referral Methods
• self, GP, Medical Specialist or any other Health
  Professional
• Minimum of 5 clients to begin the group

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CPRP

• Aims
• 1. Maximise physical, psychological and social
  functioning to enable clients to live
  productively and with confidence.
• 2. Assist and encourage behaviours that may
  minimise the risk of further recurrences/exacerbat
  ions of their disease.

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CPRP Initial Assessment

• Medical history
• Social History
• Measure of exercise tolerance
• 6 minute walk test
• Quality of life measure
• SF-36
• Goal setting

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Cardio-Pulmonary Rehabilitation Program

• 6 weeks, twice a week
• 1 hour exercise, morning tea, 1 hour education
• Multidisciplinary team Physiotherapist, Allied
  Health Assistant, Community Health Nurse,
  Occupational Therapist, Social Worker, Dietitian,
  Aboriginal Liaison Officer.
• Exercise session warm-up, treadmill, bike,
  stairs, upper and lower limb strengthening, cool
  down.
• Education session 5 cardiac, 4 respiratory, 3
  combined sessions.

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CPRP

• Discharge assessment 6MWT, SF-36
• 3,6 and 12 month follow-up
• Barriers
• Events or hospital admissions
• 6MWT
• SF-36

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Evolution

• Primary prevention
• inclusion of cardiac risk factor clients
• Maintenance CPRP
• Lack of community options
• Heart Time
• weekly exercise and education sessions for
  Aboriginal Women

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Celebrating Achievements

• Outcomes (mid 2004-2006)
• Number of referrals 75
• Number of initial assessments 51
• Number of groups 8
• Number of clients completing the program
  33
• Number of clients completing 12 month
  follow-up 19
• Number of hospital admissions 4 (2 clients)

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Table 1. Mean 6MWT distance for CPRP.
Note A higher score on the SF-36 scale
indicates higher functioning. Table 2. Mean SF-36
Scale Scores for CPRP.
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Patient Satisfaction Questionnaire

• I cannot stress further, how the (exercise)
  sessions motivated me to be active and continue
  exerciseimportant also, the other participants
  were keen, encouragement to one another
• It is a shame people dont get this education
  before they have a health problem
• Definite advantage to know how far you can go
  (exercise). Gave you confidence to get back to
  quality of life while under and away from their
  care
• I found it very important to know that others
  were out there and shared their experiences
  willingly
• I entered the exercise program rather timidly
  because when I tried at home to upgrade my
  exercise program I was increasingly breathless
  and had some angina. But I gained confidence
  under supervisionand increased my activity with
  less breathlessness

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Future Directions

• Evening CPRP
• Stronger focus on primary prevention
• CPRP at other sites within RDHS
• Aboriginal Mens Program

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Identifying Opportunities

• Well documented the benefits of cardiac and
  pulmonary rehabilitation
• Considerations in a rural remote setting
• Combination of diagnostic groups eg cardiac,
  respiratory, diabetes, obesity
• Primary, as well as secondary cardiac prevention
• Provide services not provided in the community
  e.g. exercise group
• Be flexible, tailor the program for your area eg
  Heart Time
• Program can be transdisciplinary

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References

• Recommended framework for Cardiac Rehabilitation
  04. National Heart Foundation of Australia and
  Australian Cardiac Rehabilitation Association.
  http//www.heartfoundation.com.au/downloads/CR_04_
  Rec_Final.pdf
• Pulmonary Rehabilitation Toolkit (2006). The
  Australian Lung Foundation and Australian
  Physiotherapy Association. www.pulmonaryrehab.com.
  au
• Strengthening Cardiac Rehabilitation and
  Secondary Prevention for Aboriginal and Torres
  Strait Islander Peoples. A Guide for Health
  Professionals. NHMRC (2005).

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