1. Generic Cardiac Rehabilitation Roles:
Expanding and Securing the Occupational Therapy Role in a Heart Failure Cardiac Rehabilitation Programme
Sarah Quinlan, Occupational Therapist, Cardiac Rehabilitation:
Rationale:
Occupational Therapists (OT) are a core member of a multidisciplinary cardiac rehabilitation programme (BACPR 2012). As an allied health professional, OTs should be working to support integration and challenge historical service boundaries (Chief Allied Health Professions Team, 2017).
Purpose:
To integrate the OT role into a Heart Failure (HF) Cardiac Rehabilitation Team. To challenge the boundaries of practice by developing generic competencies within a multidisciplinary team, alongside the delivery of OT specific interventions.
Method:
Establish the OT as a ‘trusted assessor’ (shadowing/joint working/training/competencies)
Integration of specific OT therapeutic interventions: fatigue management, activity analysis, relaxation, stress management, anxiety management
Offer home based programme: to include therapeutic interventions alongside clinical checks and provision of strength and balance exercises
Outcome measures: Hospital Anxiety and Depression Scale (HADS), Dartmouth COOP Quality of Life Scale (QOL), self rating scale (0-10) of goal achievement, Short Falls Efficacy Scale-1 (FES-1), Timed Up and Go (TUAG), Tinnetti gait and balance scale
Intervention: The OT role
Generic Cardiac Rehabilitation Roles:
Clinical assessment: blood pressure monitoring, ECG recording/ basic interpretation
Pre-exercise suitability checks
Strength and balance functional assessments
Exercise intensity monitoring- pulse checks/RPE scale
Home Visits:
Equipment provision
Adaptations
Falls prevention home environment assessment
Strengthening exercises
Clinical review: blood pressure/ECG/oedema/oxygen saturations
(may reduce need for HF nurse home visit)
OT clinics:
Fatigue management
Activity pacing
Task modification
Energy conservation
Goal setting
Group well-being sessions: anxiety management, thinking styles, problem solving
Home and clinic based appointments
Results
Outcome measures:
TUAG reduced from 18 seconds to 14 seconds (high falls risk over 15 seconds)
FES-1 reduced from 11 to 9 (indicating reduced psychological fear of falling)
Tinnetti increased from 20 to 22 (changing from high/mod falls risk to mod falls risk)
HAD scores; Anxiety reduced from 10 to 7/ Depression reduced from 9 to 7 (score of 7 or below is ‘normal’)
COOP score reduced by 18% (indicating improved QOL)
Self rated goals; 80% achieved goal 1 and 70% achieved goal 2 (functional individual goals)
Conclusion:
This approach has enabled an OT to become a fully integrated and integral member of the HF cardiac rehabilitation team:
In order to ‘increase the value’ of therapy positions it may be necessary to develop wider competencies with appropriate training
The development of extra skills should not be seen as a challenge to OT identity
References
British Association for Cardiovascular Prevention and Rehabilitation. (2012) Standards and Core Components. BACPR:London.
Chief Allied Health Professionals Team (2017). AHPs into Action: Using Allied Health Professionals to Transform Health, Care and Wellbeing. London.