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

Carla Simonelli, Michele Vitacca, Nicolino Ambrosino, Simonetta Scalvini, Francesca Rivadossi, Manuela Saleri, Aubin G Fokom, Ilaria Speltoni, Riccardo Ghirardi and Mara Paneroni
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Carla Simonelli: Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Michele Vitacca: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Nicolino Ambrosino: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, 27040 Montescano (PV), Italy
Simonetta Scalvini: Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Francesca Rivadossi: Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Manuela Saleri: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Aubin G Fokom: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Ilaria Speltoni: Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Riccardo Ghirardi: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy
Mara Paneroni: Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy

IJERPH, 2020, vol. 17, issue 3, 1-13

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) cmH 2 O), 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: cardiac rehabilitation; pulmonary rehabilitation; exercise; training; algorithm; physiotherapist protocol; driven protocols (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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