Physical Therapy

Question:
Discuss why you think physical therapy is important in treating patients with COPD and how you will use your academic knowledge and information in your practice.

 
Answer:
Importance Of Physical Therapy In COPD

Chronic Obstructive Pulmonary Disease (COPD) is a common term to describe different progressive lung diseases like chronic bronchitis, asthma, and emphysema. It is characterized by increasing breathlessness. COPD is caused by smoking, environmental lung irritants like chemicals, dust or fumes, and genetic factors. It is the tenth most prevalent disease worldwide and fifth leading cause of death in the world. Physical therapist work in collaboration with rehabilitation team to improve patients exercises capacity, physical and mental strength, and quality of life. They help patients with COPD to improve shortness of breath and teach them to cope with COPD. They assist them in special exercise so that patiently becomes physically active. To improve the problem of breathing, they inspiratory muscle training to reduce shortness of breath and increase exercise capacity (Troosters et al., 2013).

Appropriate Goals And Design A Plan Of Care For Patients With COPD Using Clinical Decision Making Strategies 

The proper plan of care for patients are as follows:

Initial assessment of patients: The first plan of a physical therapist is to review patient’s medical history like smoking habits, exposure to environmental irritants like toxic chemicals, cases of hospitalization due to breathing problems. They will assess particular patients use of current medication. They will check all pulmonary function test and check whether their symptoms have worsened or not. They will enquire patients what things relieves their symptoms and perform walk test to measure individual exercise capacity. All this assessment will help the therapist to plan out treatment procedure (Alessandrini et al., 2016).

Improving patients physical ability: Physical therapist will plan out the particular exercise to increase patients aerobic capacity and reduce shortness of breath. They will guide patients in using recumbent bike and treadmill to improve cardiovascular endurance. This will train the muscle used in walking and muscle of arms. This strength training exercise will help patient with moderate to severe COPD to increase their muscle mass and strength. The physiotherapist plan will be to provide strengthening exercise by using resistance bands and weights (Zwakman et al., 2015.

Improving balance in the patient: Patients with COPD suffer from decreased functional ability and mobility. It can cause a problem in stability and lead to more risk of falls in the patient. The physiotherapist aim will be to perform balance test to assess the possibility of a decline in patients. Based on the analysis, physiotherapist plan out an exercise that can improve patient’s balance and make them steady while standing (Celli, 2014).

Reduce risk factors: Physiotherapist goal is to reduce exposure to tobacco smoke, environmental pollutants to prevent the progression of COPD. They can encourage patients to quit. Practical counseling can be given to patients by way of social support (Rocker & Cook, 2013).

 
Components Of Pulmonary Rehabilitation Programs As Outlined By American Association Of Cardiovascular And Pulmonary Rehabilitation

Pulmonary rehabilitation program includes the following:

Limitation and intervention in exercise performance: It identifies factors responsible for exercise intolerance like limitations in gas exchange, cardiac and respiratory muscle dysfunction, etc. There are exercise programs to give training to patients and address their limitations like ventilator limitations, gas exchange problem and skeletal or muscle dysfunction. There are guidelines on endurance and strength training.

Body composition abnormalities and intervention: It discusses all kind of body function abnormalities like muscle wasting. It is checked by BMI and fat and fat-free mass of the individual. It is associated with high rate of morbidity and mortality. Therapeutic interventions are given like caloric supplementation, physiological intervention like strength training, the pharmacological intervention like administration of anabolic steroids. These steroids help in stimulation protein synthesis, myostatin gene regulation, and erythropoietic action.

Self-management education: The primary factor for self-management of COPD is educating the patient. There is a different style of teaching in pulmonary rehabilitation. The programme has given strategies to enhance self-efficacy by curriculum development, prevention and early treatment of exacerbation, decision making, breathing strategies and bronchial hygiene techniques.

Psychological and social consideration: Psychological and social support in rehabilitation programmed facilitates adaptive thoughts and behaviors, and help patients to eliminate negative thoughts and provide social support (Spruit et al., 2013).

Role Of Physical Therapy

Physical therapy plays a role in improving ventilation for people with a respiratory disease by using various techniques like breathing exercise, bronchopulmonary hygiene techniques and physical exercise for respiratory muscles. It has a role in improving health-related quality of life of patients and inspiratory muscle strength. Long-term benefits decrease in morbidity, and it is crucial for the delivery of effective exercise training programme (Fan, 2012).

Evidence Related Physical Therapy Intervention

This is real life experience of 68-year-old man with COPD. He was a chain smoker for 40 years before he quit smoking. He had the problem in climbing and downstairs, shortness of breath and trouble golfing. 6-minute walk test was performed on him by physical therapist, and it revealed that it reduced his exercise capacity. Other test showed that he had decreased leg strength and endurance. His physical therapist taught him how to use treadmill, upper-body ergometer and strengthening exercise with weight. He was given training on pursed lip breathing and diaphragm breathing and conserve his energy. It was useful for the patient as he can walk 200 feet farther and his breathing problem, and leg fatigue have reduced (Bo et al., 2014). 

Pulmonary Function Test

Pulmonary function examines how the lungs are moving air in and out. It tests how lung circulates oxygen to the blood. It is performed by trained staff by using special breathing techniques. Individuals with COPD show abnormal test results like airway blockage and air trapping. The low value of diffusing capacity test suggests emphysema. The test is dependent on health of lungs, effort of patient and type of equipment. It helps in determining how serious the disorder is in patients. It is also useful while preparing for lung surgery. The common test includes spirometry, diffusing capacity, chest X-ray, etc (Severgnini et al., 2013).

Airway Clearance Technique

Coughing: It is the best airway clearance technique. COPD patients have increased production of mucus leading to airway blockage. It inhibits breathing, and such patients have more chance of bacterial infection in lungs. Learning how to cough properly is the best way of air clearance.

Chest Physiotherapy: It is measured manually or with airway clearance device. It is done manually by clapping on the test to loosen mucus secretion. It is an effective way for airway clearance.

Postural drainage: It is a technique that employs gravity to assist in removal of secretion in the airway. It is performed in 12 different positions depending on the area of lungs.

Expectorants: It is a cough medicine that helps in loosening mucus in lungs (Osadnik et al., 2013).

 
Reference

Alessandrini, E., Eckman, M. H., Warm, E. J., Panos, R. J., & Zafar, M. A. (2016). Understanding Failures In Delivery Of Care For COPD Patients With 30-Day Readmission; Exploring Process Improvement Opportunities. In A23. UNDERSTANDING AND REDUCING COPD REHOSPITALIZATIONS (pp. A1114-A1114). American Thoracic Society.

Bo, K., Berghmans, B., Morkved, S., & Van Kampen, M. (2014). Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier Health Sciences.

Celli, B. R. (2014). Counterpoint: should storefront clinics provide case finding and chronic care for COPD? No. CHEST Journal, 145(6), 1193-1194.

Fan, E. (2012). Critical illness neuromyopathy and the role of physical therapy and rehabilitation in critically ill patients. Respiratory care, 57(6), 933-946.

Osadnik, C., Stuart-Andrews, C., Ellis, S., Thompson, B. R., McDonald, C. F., & Holland, A. E. (2013). The effect of positive expiratory pressure for airway clearance on ventilation inhomogeneity in individuals with stable COPD and chronic sputum expectoration. European Respiratory Journal,42(Suppl 57), P3166.

Rocker, G. M., & Cook, D. (2013). ‘INSPIRED’Approaches to Better Care for Patients with Advanced COPD. Clinical & Investigative Medicine, 36(3), 114-120.

Severgnini, P., Selmo, G., Lanza, C., Chiesa, A., Frigerio, A., Bacuzzi, A., … & Schultz, M. J. (2013). Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. The Journal of the American Society of Anesthesiologists, 118(6), 1307-1321.

Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., … & Pitta, F. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American journal of respiratory and critical care medicine,188(8), e13-e64.

Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K. (2013). Improving physical activity in COPD: towards a new paradigm. Respir Res, 14(1), 115.

Zwakman, M., Weldam, S., Lammers, J. W., & Schuurmans, M. (2015). Patient perspectives of the COPD-GRIP intervention, a new nursing care intervention in COPD. European Respiratory Journal, 46(suppl 59), PA328.

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