CHF In-Home Program Guidelines for PT & OT Evaluation and Care Planning 1
Objectives After completing the Therapy CHF guidelines training, you will be able to Determine when PT and OT evaluations are recommended Describe what evidenced based assessments should be included during PT and OT evaluations to assist proper care planning and goal setting Understand Exercise Guidelines for proper exercise prescription and patient monitoring Determine when to consult other medical personnel secondary to patient change in medical status or activity tolerance Understand therapies impact on CHF clinical outcomes 2
When is PT and/or OT recommended? A Physical Therapy Evaluation is ALWAYS recommended for a patient with heart failure and a NYHA Classification Score of II, III or IV and/or functional deficits determined by the OASIS as a F2 or F3 in the Functional Domain An Occupational Therapy Evaluation may be recommended for a patient with heart failure and a NYHA Classification Score of II, III, or IV and/or functional deficits determined by the OASIS as a F2 or F3 in the Functional Domain. **See General Guidelines for other Cardiac Dx recommendations** 3
PT and OT Assessment Tools PT: 30 Second Sit-to-Stand Tinetti POMA 6MWT (Six Minute Walk Test) or 2MST (Two Minute Step Test) OT: Barthel Index Borg s Rating of Perceived Exertion (with ADLs) Borg s Dyspnea Scale (with ADLs) 4
PT Goals for the Cardiac Patient Patient will demonstrate improvement in functional LE Strength and/or standing tolerance to safely and efficiently perform standing ADLs and self-care tasks, i.e. Daily weights to monitor fluid retention Test/Measure: A. 30 Second Sit-to-Stand or B. Borg RPE Patient will demonstrate improvement in strength/balance to safely perform gait ADLS w/o chest pain, debilitating dyspnea, balance deficits, or claudication Test/Measure: Tinetti POMA Patient will demonstrate improvement in aerobic capacity to safely perform necessary ADLs/IADLs Test/Measure: A. 6MWT or B. 2MST 5
OT Goals for the Cardiac Patient Patient will demonstrate improvement in activity tolerance to safely and efficiently perform ADLs and self-care tasks, i.e. daily weights to monitor fluid retention Test/Measure: A. Barthel Index or B. Borg RPE Patient will demonstrate improvement in dyspnea to safely perform necessary dressing ADLs/IADLs Test/Measure: Borg s Dyspnea Scale Patient will demonstrate improvement in energy conservation techniques to safely perform ADLs with the least amount of exertion Test/Measure: Borg s Perceived Rating of Exertion 6
Exercise and Activity Guidelines 7
Patient Status Change and Clinical Consult Therapists working with patients who have congestive heart failure in the sub-acute care setting should monitor the patient s status. If a patient demonstrates deterioration in physical or functional condition during physical activity or exercise, other medical personnel should be consulted. Some signs to look for include: Rapid weight gain Girth measurement changes Pitting edema (see Table 1) A decrease in heart rate of 10 bpm or decrease in blood pressure of 10 mm Hg. An increase in respiration rate to greater than 40 respirations per minute Rating of perceived exertion (RPE) increasing above 4/10 (moderate exertion) Unexpected decline in distance walked on a 6-minute walk test Increased pulmonary rales or dyspnea Diaphoresis, pallor, and/or confusion. 8
CMS: Home Health Compare 9
Rehab s impact on Outcomes 10