Competency: Resistance Training in Outpatient Cardiac ...



Competency: Six Minute Walk Test (6MWT) as a Measure of Functional Capacity in Outpatient Cardiac/Pulmonary Rehab Patients Name _______________________ Date _________ Department: Cardiac Rehab Expectation: The rehab staff will demonstrate correct methods of preparing, instructing, performing, and documenting the walk test as a cardiac rehab clinical outcome & as program performance measure. Critical Elements: The rehab staff will be able to: ProficientNeeds Review/ ImprovementInadequate **PRE 6MWT1Recognize the 6MWT as a submaximal exercise testing procedure 2Identify appropriate patients to participate, following policy for indications & contraindications3Communicate advance instructions to patient by phone or mail: Wear walking shoes If needed, bring own oxygen & usual walking aids, e.g. cane, walker. Take usual meds at usual times 4Prepare for possible emergencies during the test: Location of crash/cart/defibrillator Availability of supervising MD Access to emergency medications = albuterol, nitrogylycerin, oxygen Means of calling for help 5Set-up space & equipment in advance: Flat unimpeded walking path, ideally 100 linear feet Cones to mark ends of walking path Chairs for patient to stop if needed Stop-watch or other timer Poster of 0-10 rating scale for RPE Clipboard with script of patient instructions & report form to record laps & responses B/P cuff & stethoscope Wearable oximeter Telemetry monitoring hook-up 6Position patient in a chair near start of walking path to: Relax & breathe quietly 5-10 minutes Confirm that usual meds were taken & that oxygen is set at usual levels Attach telemetry & oximetry Have BP equipment ready nearby Remember that no warm-up is needed 7Discuss the importance of following a standardized procedure for test performance to help assure reproducibility DURING 6MWT 8Perform pre-test measurements: Heart rate, BP, O2 sat., RPE Cardiac rhythm strip from telemetry9Explain that this is a self-paced walking test for the purpose of seeing HOW FAR a person can walk in 6 minutes time 10Read ATS scripted instructions to each patient for each test 11Demonstrate correct walking technique such as: Where to walk out & back How to go around cones without slowing down 12Select a mid-point along the path to stand for best observation & coaching, including visualization of oximeter data as patient passes by 13Give rationale for NOT walking with patient, unless there is a safety issue or fall risk, then walk behind patient to not influence their pace 14.Provide scripted instructions every 1 minute during test = DO NOT use other words of encouragement 15Allow patient to stop & rest if needed = lean against wall or sit down, but clock keeps ticking 16When stops occur, use scripted instruction every 30 seconds to “please resume walking whenever you feel able” Note time stopped & when re-started17Monitor HR & rhythm on telemetry each minute of test Without interrupting walking pace, have patient hold up hand to see oximeter data when passing by18As 6 minute endpoint approaches, warn patient that “time is almost up, when I say STOP, please stop where you are & I will come to you”. 19At 6 minutes, go to patient’s side to:Obtain HR & O2 sat data Take blood pressure Ask RPE on 0-10 rating scale Ask about any discomfort experienced POST 6MWT 20Have patient sit in chair & relax for 5-10 minutes; repeat vital signs 21Complete test documentation including Total distance walked Number & length of stops Lowest O2 sat & highest HR observed during test Signs/symptoms reported If stopped early, reason could not go farther 22Translate total distance walked into mph & METs to help with starting exercise training on the treadmill 23After exit walk, compare results to entry walk data & explain extent of change to patient 24Identify that a clinically significant change from entry to exit test is 10% improvement in distance walked = the minimal important difference (MID) to indicate functional improvement as a result of rehab Resources: For knowledge For skills ATS/ERS Technical Standard: Field walking tests in chronic respiratory disease; European Respiratory Journal, 44:6; December 2014; 1428-1446. AACVPR CR Performance Measures 2018; Functional Capacity Measurement; . Instruction/demonstration session by a staff member experienced in 6’ walk performance Practice & return demonstration to each other Observation of an actual test on a CR patientCross-reference to: AACVPR Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals:2010 Update; JCRP 2011 pg. 8: Physical Activity Counseling, Skill bullet #1 Exercise Training Evaluation, Skill bullet 8. Evaluation: Signature _______________________________ Date ________________ ** any/all ratings of Inadequate require a corrective action plan tailored to the staff member involved ................
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