The Right Stuff
The Right Stuff
Here’s what a physical therapist should know about your patient before a exercise program can be recommended, according to Scot Irwin, DPT, professor of physical therapy at North Georgia College in Dahlonega.
- Exercise test results (either formal or baseline functional test like walking)
- Ejection fraction
- Medications
- Pathology
- NYHA Class
"If we have these things, pretty much, the physical therapist will be able to give a fuller picture to the physician," Irwin says.
How patients can approach physical therapists varies from state to state.
In Pennsylvania, for example, patients must be referred by a physician, says Chris Wells, PT, a doctoral candidate at the University of Pittsburgh. Other states, like Georgia, give patients direct access to them. (Insurers, however, may vary on their requirements for referral.)
Irwin says a general physical therapist probably could handle patients in class I and II disease. But when patients enter class III, that’s the time a specialist should be consulted.
This is especially important if the patients have an ejection fraction of 25% or suffer from comorbidities like arrhythmia, neurologic conditions, or angina. These physical therapists need to be able to recognize symptoms with patients who have a limited activity threshold. Patients in class IV won’t be looking for exercise. Therapy here focuses on learning to live with the energy cost in simple movement.
Balance programs for patients’ conditions
As far as knowing which program a doctor could recommend, Irwin notes heart failure presents a dynamic that a program should address: There needs to be a balance between stimulating patients for improvement without pushing them into heart failure. "It’s a touchy spot," he says.
If you go the formal cardiorehab center route, make sure the patients can get into programs tailored for their specific needs. Irwin says that not all of them are individualized to meet the needs of every patient. That may not be helpful to a heart failure patient, who probably will have specific needs and concerns.
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