KNGF Guideline Cardiac rehabilitation

KNGF Clinical Practice Guideline for physical therapy in patients undergoing cardiac rehabilitation
Practice Guidelines
Table 10. Evaluation and screening instruments for each goal in physical therapy for chronic heart failure.
goal final outcome evaluation instrument when
specific physical goals
I. optimizing
exercise capacity
Exercise capacity is at
optimum or target level for
this patient
by physician
• maximum or symptom-limited
exercise test with gas analysis
plus Borg RPE scale (6–20);
possibly scoring Anxiety, Angina
and/or Dyspnea scales
maximum or symptom-limited
exercise test with gas analysis and
KVL-H questionnaire at start and
end of training program
by cardiac rehabilitation
coordinator
• subjective physical score on
KVL-H questionnaire
Functional exercise capacity
is at optimum or target
level.
by physical therapist
• as for goals 1 and 2
• (modified) SWT
• possibly MET method and/or SAS
at start, every 4 weeks and at end
of training program
II. balancing exertion with
physical abilities
Patient (and partner) coping
effectively with symptoms,
that is, patient avoids
excessive strain and (if
possible) improves exercise
capacity (goal 1). Patient is
able to spread their energy
expenditure and to deal
with their dyspnea in a
functional way.
• compare subjective exercise
capacity score with objective
score
• ask for 5 most problematic
activities (PSC) and score these
on the Borg RPE scale (6–20);
possibly score Anxiety and/or
Angina and/or Dyspnea scales
at start and end of rehabilitation
and / or training program, but
also continuous evaluation to
check for excessive strain
III. reducing fatigue,
dyspnea and inactivity
Patient’s sensation of
dyspnea is at optimum or
target level. Patient has
adopted a physically active
lifestyle.
• Borg RPE scale (6–20) and
Dyspnea scale for fatigue and
dyspnea
• Monitor Bewegen en
Gezondheid, see goal 4
(www.tno.nl) (in Dutch)
at start and at end of
rehabilitation and / or training
program
general physical goals
1. exploring one’s
own physical limits
2. learning to cope with
physical limitations
Patient is aware of their
own physical limits, that
is, they know what level of
physical exertion is possible.
Patient is able to cope with
their physical limitations
and utilize their limited
energy efficiently, and has
achieved a balance between
exertion and relaxation.
• ask for 5 most problematic
activities (PSC)
• ask patient to carry out problematic
activities and possibly
score them for duration and
quality, or using the Anxiety
and / or Angina and / or Dyspnea
scales.
• score using Borg RPE scale
(6–20) for fatigue and dyspnea,
if indicated
at start and end of rehabilitation
and / or training program; monitoring
heart rate, measuring blood
pressure and scoring on Borg scale
before, during and after each
session
V-08/2011
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