Intended Learning Outcomes -
Cardiopulmonary Physiotherapy
Section 1 (Introduction and review of respiratory physiology)
Introduction
- course introduction
Introduction to cardiopulmonary physiotherapy
- appreciate the various services provided by a cardiopulmonary physiotherapist
- identify clients that require cardiopulmonary physiotherapy
- understand the role of a cardiopulmonary physiotherapist in acute care, outpatient and community settings
Review of respiratory physiology: mechanics of breathing
- explain the physiology underpinning respiratory techniques commonly employed by a respiratory physiotherapist, such as cough, huff and breathing exercise
- apply the concepts of equal pressure point, airway and elastic resistance, pulmonary compliance, work of breathing, and the relationship between pleural pressure, alveolar expansion and ventilation
- use the above concepts to assist with clinical decisions associated with positioing of patients and the selection of appropriate interventions that address issues relevant to a patient's respiratory mechanics
Review of respiratory physiology: ventilation and perfusion relationship
- explain the regional variation of ventilation and perfusion within the lungs
- identify factors that influence intrapulmonary shunting of blood
- provide reasoning for selection of an appropriate position to maximise lung volume and/or ventilation
- determine an appropriate strategy to maximise oxygenation through positioning
Oxygen therapy
- apply various oxygen delivery systems to a patient
- facilitate appropriate oxygen therapy to a patient
- advise patients on the use of supplementary oxygen as appropriate
- understand the risks of supplementary oxygen
Humidification and inhalation therapy
- make clinical decision as to whether inhalation therapy (humidification or nebulisation) is indicated for a patient
- apply appropriate means to improve humidification of the airway
- teach the patient proper use of an nebuliser
- instruct patients the appropriate use of various meter dosed inhalers
Section 2 (Physiotherapy assessment and cardiopulmonary physiotherapy intervention)
Understanding spirometry
- conduct an accurate spirometry test
- interpret the numerical and graphical spirometry data
- recognise the various spirometry patterns associated with restrictive and obstructive pulmonary disease
- appreciate the American Thoracic Society recommendations for presenting spirometry test data
- appropriately use spirometry data as an outcome measure to evaluate a physiotherapy intervention
Review of auscultation techniques
- understand the components of a stethoscope
- provide appropriate patient instruction to gain cooperation during the auscultation procedure
- appropriately position the patient and place stethoscope to obtain optimal lung sound quality
- understand the internationally recognised lung sound nomenclature
- interpret the characteristics of lung sounds heard through the stethoscope
Assessment of respiratory function
- conduct a patient interview and ask appropriate questioning relating to a patient’s respiratory condition
- perform essential physical examination procedures in a patient with respiratory disease
- identify a patient’s problems from assessment findings in order of importance from the clinical evidence
- relate assessment findings to the pathophysiological presentation
- monitor appropriate measurable outcomes as indicators of progression of the patient’s respiratory condition
An overview of objective data which reflect the level of respiratory function
- identify abnormal oxygenation and ventilation in a patient by interpretating a blood gases analysis profile and pulse oximetry
- interpret spirometric analysis of lung volume and airflow
- interpret normal and abnormal features of a chest radiograph
- measure an exhaled carbon monoxide level
- appreciate the role of thoracic ultrasound in monitoring breathing pattern and diaphragm thickness
Airway Clearance Techniques
- describe the concept of airway clearance
- select an airway clearance technique (ACT), underpinned by current best evidence, that is appropriate to the patient’s pathophysiological condition
- apply the appropriate airway clearance techniques covered in the lecture
- evaluate the effectiveness of an ACT with appropriate outcome measures
- make clinical decision regarding the needs of adjunctive therapy devices to assist airway clearance
Techniques to improve lung volume and ventilation
- identify indications for the need to employ techniques to improve a patient’s ventilation or lung volume
- perform techniques commonly used by physiotherapists to promote pulmonary ventilation
- based on the patient’s pathophysiological condition, make clinical decision on selection of the appropriate technique for improvement of lung volume or ventilation
Section 3 (Management of COPD, pulmonary rehabilitation and paediatric care)
Management of patients with COPD
- describe the pathophysiology, diagnosis, signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD)
- explain current mainstream medical management strategies for COPD
- conduct an appropriate physiotherapy assessment
- plan and implement appropriate intervention and education for patients with COPD
- select appropriate outcome measures to determine effectiveness of the management program
- recognise the risks associated with supplementary oxygen administration in patients with COPD of supplementary oxygen administration in patients with COPD
- identify global management guidelines for COPD
Management of patients with lung cancer
- interpret global epidemiology of lung cancer
- describe the causes and major risk factors associated with lung cancer
- understand the common tumour types and key molecular drivers relevant to contemporary treatment
- explain contemporary medical management pathways of lung cancer
- comprehend the full scope of physiotherapy practice in lung cancer care- from prevention and early detection to exercise prescription, peri-operative care and rehabilitation exercise
- Physiotherapy in Thoracic Surgery
- describe the common types of thoracic surgery
- recognise the physiological and musculoskeletal trauma associated with open thoracotomy and VATS
- appreciate the emergence of robotic-assisted thoracic surgery
- explain how the different surgical approaches influence the role of physiotherapy in optimising outcomes
- comprehend the full scope of physiotherapy in peri-operative thoracic surgery care
Pulmonary rehabilitation and exercise prescription
- identify and prioritise each patient’s needs for pulmonary rehabilitation
- work with the patient to identify SMART goals during the various stages of pulmonary rehabilitation
- prescribe an appropriate individual exercise program based on patient assessment
- work collaboratively with other members of the pulmonary rehabilitation team
Role of physiotherapy in paediatric respiratory care
- identify the anatomical differences in the adult and neonatal respiratory system
- consider an appropriate position to maximise lung volume or ventilation in a neonate
- recognise the role of physiotherapy at different stages of common paediatric respiratory conditions
- identify the indications for physiotherapy in children with spinal muscular atrophy (SMA)
- assess the need for and provide, appropriate pre and post operative interventions, in children undergoing orthopaedic and cardiac surgery
Role of PT in pre-and post-surgical care
- identify risk factors that may contribute to post-surgical pulmonary complications
- appropriately provide pre- and post-surgical physiotherapy intervention
- deliver a pre-operative patient assessment and provide appropriate pre-operative advice and intervention for the patient
- conduct an appropriate post-operative assessment
- perform appropriate post-operative intervention followed by assessment of outcome
- consider discharge criteria for a patient
- formulate a comprehensive discharge plan for the patient prior to returning home
Prescribing breathing devices in respiratory care
- understand the working mechanisms of different breathing devices
- recognise indications for use of a breathing device in the appropriate patient
- provide clear instructions to patients on the use of a breathing device
- provide prescription of an appropriate program to a patient which may benefit from the use of a breathing device
Section 4 (Cardiac rehabilitation)
Interpretation of ECG – implications for physiotherapists
- understand the conducting system of the heart
- recognise the difference between a normal and disrupted electrical rhythm
- conduct a systematic approach to interpreting an ECG pattern
- appreciate the implications of various ECG patterns for physiotherapy
- make appropriate decisions as to whether a physiotherapy intervention should terminate or continue with a change in ECG pattern
Management of Cardiovascular disease
- define different type of cardiovascular diseases
- describe the relevant pathophysiology and risk factors of various cardiovascular diseases and heart failure
- explain various methods of diagnosis coronary artery disease
- aware of the clinical pathway for management of acute coronary syndrome and heart failure
- assess and monitor variable risk factors of cardiovascular disease
- understand the role of physiotherapy in management of clients with or at risk of cardiovascular disease
Cardiac Surgery - implications for physiotherapists
- understand the current surgical management of patients with cardiac and cardiovascular disease: including coronary artery bypass grafting, valvular repair and replacement, implantable devices, aortic aneurysm, aortic dissection and pectoral flap advancement
- appreciate the role of physiotherapy in common cardiac surgical procedures in patients with concurrent cardiovascular disease
- provide appropriate advice to patients after sternotomy
- be aware of safety precautions associated with exercise prescription for patients with implantable devices
Overview of cardiac rehabilitation
- explain to clients and relevant stake holders the evolution of cardiac rehabilitation
- explain the concepts of cardiac rehabilitation
- select appropriate candidates for a cardiac rehabilitation program
- refer clients to an appropriate cardiac rehabilitation service
- participate in the planning and/or organisation of a cardiac rehabilitation program
- apply appropriate indicators to evaluate the quality of a cardiac rehabilitation program
- collaborate with other professions in the various domains of a cardiac rehabilitation program
Role of physiotherapy in phase I cardiac rehabilitation
- explain the role of physiotherapy in management for patients with cardiac conditions that require hospitalisation
- retrieve relevant information from the patient’s hospital notes
- assess the cardiac and haemodynamic status of the patient
- identify and prioritise the patient’s problems
- formulate a safe and appropriate intervention plan for a patient after acute cardiac event including myocardial infarction, acute coronary syndrome and cardiac surgery
- formulate appropriate physiotherapy discharge criteria for a patient admitted for cardiac management
Phase II cardiac rehabilitation - assessment, goal setting and exercise prescription
- assess the individual needs of participants recruited to a cardiac rehabilitation program
- develop a comprehensive plan of care for participants in a cardiac rehabilitation program
- work collaboratively with other members of the cardiac rehabilitation team in assessment and goal-setting for participants undertaking a Phase II cardiac rehabilitation program
- apply the principle of exercise prescription to participants in a cardiac rehabilitation program
- modify the exercise protocol based on the patient’s responses to exercise training
- document the mode of exercise and patient response following each exercise session
- prescribe an individualised home exercise program for a patient based on the patient’s response to supervised exercise
- evaluate the effectiveness of an exercise program
Section 5 (Physiotherapy in ICU care)
Introduction to critical care and monitoring in ICU
- understand the organisation and management of an ICU
- describe the general management of the critically ill in the ICU
- explain the need for early mobilisation in ICU patients
- describe the commonly used outcome measures that reflect the oxygenation status of an ICU patient
- describe and interpret capnogram data
- describe and interpret the data which provide the haemodynamic profile of a patient
- interpret the data elicited by various neurological assessment tools
- explain and perform a Physical Function ICU Test and ICU mobility test
- work together with the ICU team in proning an intubated patient
- work collaboratively with other members in the ICU team
Management of the critically ill – Sepsis and ARDS
- be aware of the ABCDEF bundle of care in ICU
- be aware of the scoring system for severity of illness in an ICU patient
- recognise the importance of maintaining fluid and electrolyte balance in an ICU patient
- understand the pathophysiology of sepsis and ARDS
- appreciate the current management of patients on Extra Corporeal Membrane Oxygenation (ECMO)
- be aware of management of renal failure in ICU
- describe the role for physiotherapy in ameliorating post-ICU syndrome
Principle of mechanical ventilation
- define the types of respiratory failure
- explain the indications for mechanical ventilation
- describe common modes of mechanical ventilation
- understand the concept of lung recruitment
- appreciate the role of physiotherapist during weaning from mechanical ventilation
Manual hyperinflation (MHI), ventilator hyperinflation (VHI) and non-invasive ventilation (NIV)
- describe the process of manual hyperinflation
- select appropriate patients who will benefit from manual hyperinflation
- describe the process of ventilator hyperinflation
- understand various protocols of VHI reported in the literature
- describe and apply appropriate selection criteria for patients to undergo ventilator hyperinflation
- explain the clinical use of non-invasive ventilation
Role of physiotherapy in ICU care
- describe the role of a physiotherapist in ICU
- provide an appropriate assessment for physiotherapy procedure in ICU
- recognise factors that inhibit patient mobilisation in ICU
- apply appropriate outcome measures to determine effectiveness of physiotherapy care delivered in an ICU environment
Role of physiotherapy in management of acute and long COVID-19
- be able to describe the pathophysiology of COVID-19 and clinical presentation of the disease
- understand the role of physiotherapy in the management of patients with acute COVID-19
- appreciate the special considerations necessary for delivery of pulmonary rehabilitation to patients with long COVID
- be aware of the international clinical practice guidelines for the diagnosis and management of Long COVID
Physiotherapy documentation
- understand the need to document each physiotherapy assessment, intervention and outcome
- understand the different types of clinical notes
- document a patient’s consent to physiotherapy assessment and intervention
- document a patient’s past medical history, social history, subjective and objective assessment findings
- document an intervention plan for the patient
- appreciate how quality intervention documentation reflects clinical reasoning