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A5048 - COPD Physical Therapy Program
Author Block: S. Patel1, K. Gafoor1, H. M. Belete1, M. Oron1, V. Shah1, E. L. Altschul1, J. Homan1, B. McCaffrey2, B. A. Mina1; 1Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, United States, 2Physical Therapy, Lenox Hill Hospital - Northwell Health, New York, NY, United States.
Introduction: The primary goal for inpatient physical therapy (PT) for a patient with pulmonary disease is to maximize his or her functional independence and endurance while minimizing secondary impairments as a result of their lung disease and hospital admission. We implemented a PT program for patients admitted with an acute exacerbation of COPD (AECOPD) in an attempt to reduce hospital length of stay and improve exercise capacity. Methods We implemented our PT program on March 15th 2017 at our community hospital. Patients admitted with a diagnosis of AECOPD were included. The program was provided 6 days a week and centered on 5 aspects of care. 1) Therapeutic exercises which included progress from supine, sitting, and standing adding repetitions and then resistance as tolerated. Breathing techniques and relaxation exercises including diaphragmatic breathing, pursed lip breathing and coughing. Postural exercises to improve breathing pattern and chest wall flexibility. 2) Endurance Training - Increasing distance and frequency of ambulation and tolerance to sitting in a bedside chair. 3) Functional mobility training which included transferring from bed to chair, wheelchair or commode. 4) Gait training - Using assistive devices and weaning to the least restrictive device as tolerated. 5) Weaning of supplemental oxygen - as directed by the pulmonary service for oxygen saturation (Sp02) goal and monitor SpO2 during treatment. Education was provided to the patient and family members regarding expectations of functional outcomes, benefits of exercise and mobility training, appropriate level of assist that patients require from family and their anticipated rehabilitation progression. Personalized education was also provided on pacing activities, energy saving, relaxation techniques and emotional support as needed. Results 40 patients were enrolled in the program over a 5 month period. 30 (75%) of the patients were female with an average age of 72.2 years. The median hospital length of stay was 3 days. 34 of the 40 patients were able to return home, 13 with home care and 2 with home PT. 5 patients went to sub-acute rehabilitation and 1 to hospice. Conclusion Implementing a dedicated PT program for patients with AECOPD may help reduce hospital length of stay. 34 patients were able to return home, 2 of which requiring home PT, suggesting that most patients were able to maintain their functionality. This may have influenced the length of stay as 19 (48%) were discharged to home without requiring home services or further PT.