The role of the Physical Therapist in cardiac care rehabilitation in a skilled-nursing facility

The structured program of exercise and education known as "cardiac rehabilitation" is designed to help patients return to optimal fitness and function following an event such as a heart attack. The program begins immediately after treatment, in a hospital room or ICU, and progresses through recovery in a skilled-nursing facility and, if that is the plan, the return home.

The cardiac rehabilitation team will include the doctor, nurses, and physical and occupational therapists, who will work together to help improve the patient’s functional mobility, decrease risk factors related to the cardiac injury, and help the patient and his or her family manage the psychosocial effects that may influence recovery after a heart attack.

The role of the physical therapist is to help to evaluate cardiac function, assess impairments that may limit mobility, and prescribe progressive exercise and physical activity to help the patient return to a normal lifestyle after a cardiac event.

The physical therapist’s role begins during the acute phase, in the hospital after the cardiac event, and continues through the following three phases, which will occur in a skilled nursing facility, a cardiac rehab center, or home.

Phase One: The Acute Phase

The initial phase of cardiac rehabilitation occurs soon after the cardiac event. An acute care physical therapist will work closely with doctors, nurses, and other rehabilitation professionals to help the patient start to regain his or her mobility.

In the case of severe cardiac injury or surgery, such as open heart surgery, the physical therapist may start working with the patient in the intensive care unit. The initial goals of phase one cardiac rehabilitation include:

  • Assess the patient’s mobility and the effects that basic functional mobility has on the   cardiovascular system
  • Work with doctors, nurses and other therapists to ensure that appropriate discharge planning occurs
  • Prescribe safe exercises to help the patient improve mobility and improve cardiac fitness.
  • Help the patient maintain sternal precautions in the case of open heart surgery.
  • Address any risk factors that may lead to cardiac events
  • Prescribe an appropriate assistive device, like a cane or a walker, to ensure that the patient is able to move around safely
  • Work with the patient and family to provide education about the patient’s condition and the expected benefits and risks associated with a cardiac rehabilitation program

Phase Two: The Subacute Phase

When the patient is ready to leave the hospital, the cardiac rehabilitation program will continue at an outpatient facility or a skilled-nursing facility. Phase two of cardiac rehabilitation begins

here and usually lasts from 3-6 weeks; it involves continued monitoring of the patient’s cardiac responses to exercise and activity.

Upon admission, the physical therapist will evaluate and assess the patient’s condition. Various tests and measures will be assessed by the physical therapist, including but not limited to:

  •  Heart rate
  •  Blood pressure
  •  Respiration rate
  •  Sternal precautions and scar tissue mobility assessment (if necessary)
  •  Upper and lower body strength
  •  Range of motion (ROM) of various joints
  •  Overall endurance level
  •  Balance

The physical therapist may choose to perform a specific outcome measure test to assess the patient’s general functional mobility or endurance. Common tests in phase 2 cardiac rehab include the 6-Minute Walk Test and the Timed Up and Go Test.

The main treatment offered by the physical therapist during phase 2 cardiac rehab is exercise. He or she will work closely with the doctor, nurses, and other healthcare providers to ensure that the patient safely improves exercise and activity tolerance. The PT will also teach the patient various methods to measure heart rate and to monitor exercise and activity tolerance.

Another important aspect of phase two cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise.

While the patient exercises, the physical therapist will monitor the body's physiological response to movement. Heart rate, blood pressure, and oxygen saturation rate will be measured. Typical exercises during phase 2 cardiac rehab may include:

  •  Treadmill walking
  •  Stationary biking
  •  Using an upper body ergometer (UBE)
  •  Rowing
  •  Using upper and lower body strengthening machines or free weights
  •  Stretching

A closely monitored exercise and activity program is optimal during the initial sessions of phase 2 cardiac rehabilitation, but as the sessions progress, the physical therapist will likely introduce more independent activities and exercises to prepare the patient for phases 3 and 4 of cardiac rehabilitation. The main focus of these phases is independent exercise and activity and a full return to a normal, healthy lifestyle.

Phase Three: Intensive Outpatient Therapy

Phase three of cardiac rehabilitation involves more independent and group exercise. The patient should be able to monitor his or her own heart rate, symptomatic response to exercise, and rating of perceived exertion (RPE). The physical therapist will be present during this phase to help the patient to increase exercise tolerance and to monitor any negative changes that may occur.

Phase Four: Independent Ongoing Conditioning

The final phase of cardiac rehabilitation is the patient’s own independent and ongoing conditioning, which are essential to maintaining and preventing possible future cardiac problems. While phase four is an independent maintenance phase, the physical therapist is available to help make changes to the exercise routine to help the patient achieve physical fitness and wellness.

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This information is not intended to replace the advice of a doctor. Blue Sky disclaims any liability for the decisions you make based on this information.