Assessment

Pulmonary Rehabilitation: Patient Assessment (video)

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Patients attending PR undergo a comprehensive assessment looking at:

Diagnosis

• Which respiratory condition or conditions has the patient been diagnosed with.
• Forced Expiratory Volume in one second (FEV1) shows the amount of air a person can forcefully exhale in one second of their forced vital capacity (FVC). This can be helpful in diagnosis.

Exacerbations

• How often do patients have an exacerbation?
• Most recent?
• Able to identify exacerbation?
• Early identification.

Medications

• Respiratory medications and other medications including oxygen – dose / check inhaler technique.
• Vaccinations – influenza and pneumonia.

Smoking history

• Current smoker?
• How long been smoking for, cigarettes/pipe/cigar/ e-cigarette? 
• Ex-smoker, when stopped.
• Calculate pack years.
• Referral to smoking cessation services as required.

Social history 

• The patient's home circumstances, housing, stairs, mobility and exercise, activity of daily living, occupation.

Exercise capacity

• Field walking tests – ISWT or 6m walk test.

Outcome measures:

• Incremental Shuttle Walk Test (ISWT)
• 6 minute Walk Test (6mWT)
• Endurance Shuttle Walk Test (ESWT)

Leg strength

• 1RM, functional measures e.g. 5Tsts.

Outcome measures:

• Usually quads, can be done with machinery or functionally.

Health status (usually a questionnaire)

• CAT 
• St Georges 
• KBILD

Outcome measures:

• Using validated questionnaires related to specific respiratory condition, e.g. COPD Assessment Test (CAT), Kings Brief interstitial Lung Disease (KBILD).

Anxiety and depression

• PHQ-4 
• PHQ8: As PHQ9 with the 9th item removed. Eight items, each of which is scored 0 to 3, providing a 0 to 24 severity score.
• GAD-7

Outcome measures:

• Using validated questionnaires.

Goal setting 

• Joint goal setting with patient, used to guide treatment plan.

Self management

• How much does the patient know about their condition and what is important to them in their daily life when coping with long term respiratory disease?

Important:

• The assessment should be thourough and based on a two way discussion about the patient's lifestyle and symptoms.
• It is important to know what having a long term lung condition means to the patient from their perspective.
• Do they understand their medication?
• What are their goals?
• What are they concerned about regarding their physical and mental health?
• A good assessment results in the patient learning more about their condition and eager to attend rehabilitation classes.

Additional information
	Anxiety and depression Patient Health Questionnaire Screeners: PHQ4  PHQ8: As PHQ9 with the 9th item removed. Eight items, each of which is scored 0 to 3, providing a 0 to 24 severity score. GAD-7  Health Status CAT (COPD Assessment Test) St Georges Respiratory Questionnaire (SGRQ) King's Brief Interstitial Lung Disease Questionnaire (KBILD)