Functional Assessment in Pulmonary Medicine

Functional Assessment in Pulmonary Medicine - Dr.Gyanendra...

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Dr. Gyanendra Agrawal Senior Resident Dept of Pulmonary Medicine FUNCTIONAL ASSESSMENT IN PULMONARY MEDICINE
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linical Exercise Testing Clinical Exercise Testing ± Increasingly being used in clinical practice: à pact in the clinical decision making process Impact in the clinical decision making process à Resting cardiopulmonary measurements do not provide a reliable estimate of functional capacity p py rovide objective measures for diagnosis ± Provide objective measures for diagnosis, treatment and prognosis
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pes of Clinical Exercise Testing Types of Clinical Exercise Testing ± 6 minute walk test ± Shuttle walk test ± Exercise induced bronchoconstriction ± Cardiac stress test ± Cardiopulmonary exercise tests
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dications of 6MWT Indications of 6MWT ± Before and after treatment comparisons à Lung resect n , Tx à COPD, rehabilitat n ± To measure functional status à HF, COPD, PVD à Cystic fibrosis ± To predict hospitalization and death à HF, COPD à Pulm HTN
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fety Safety ± Absolute CI à SA or heart attack during previous month USA or heart attack during previous month ± Relative CI esting tachycardia (HR 120 beats/min) or à Resting tachycardia (HR 120 beats/min) or à Uncontrolled hypertension ± Physician need not be present ± Technician should be certified in CPR
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rforming 6MWT Performing 6MWT ± Should be performed indoors along long, flat, straight corridors (30 m) ± Instruct and demonstrate properly à Walk AS FAR AS POSSIBLE for 6 minutes, but don’t run or jog à Permitted to slow down, to stop, and to rest as necessary à May lean against the wall while resting ± Standard phrases for encouragement à “You are doing well” “ eep up the good work” à Keep up the good work ± If practice test is done wait for ~ 1 hr, and report the highest 6MWD g Am J Respir Crit Care Med 2002;166:111–117
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riables Measured Variables Measured ± 6MWD ± condary measures include Secondary measures include à Fatigue and dyspnea, measured by modified Borg or AS VAS à Arterial O 2 saturation ± ptimal reference equations from healthy population Optimal reference equations from healthy population not yet available MWD range from 400 to 700 m ± 6MWD range from 400 to 700 m ± Statistically significant mean increase in 6MWD in a oup of COPD patients 0 m group of COPD patients 70 m Am J Respir Crit Care Med 1997;155:1278–1282 Respir Care 2003;48(8):783–785
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terpretation Interpretation ± A low 6MWD is nonspecific and non diagnostic he following tests may then be helpful: ± The following tests may then be helpful: à Pulmonary function ardiac function à Cardiac function à Ankle–arm index à Muscle strength à Nutritional status à Orthopedic function à Cognitive function
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WHY 6MWT ???
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alk tests Walk tests ± Time based tests MWT 5MWT à 2MWT, 5MWT à 6MWT, 9MWT, 12MWT ± Fixed distance tests à 100 m, Half mile à 2 km walk test ± elocity determined tests Velocity determined tests ± Controlled pacing incremental tests à Incremental shuttle walk test
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WT on treadmill 6MWT on treadmill ±
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Functional Assessment in Pulmonary Medicine - Dr.Gyanendra...

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