Competency: Resistance Training in Outpatient Cardiac ...



Competency: Six Minute Walk Test (6MWT) as a Measure of Functional Capacity in Outpatient Pulmonary Rehab Patients Name _____________________________Department: __Pulmonary Rehab____Expectation: The pulmonary rehab therapist will demonstrate correct methods of preparing, instructing, performing, and documenting the walk test as a pulmonary rehab clinical outcome measurement. Critical Elements: The PR therapist 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 Bring usual walking aids Bring own oxygen equipment Take usual meds at usual times 4Prepare for possible emergencies during the test: Location of crash/cart/defibrillator Availability of supervising physician 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 Borg 0-10 scale for rating both RPD & fatigue Clipboard with script of patient instructions & report form to record laps & responses B/P cuff & stethoscope Wearable oximeter Telemetry monitoring = optional 6Plan for patient to use own devices during test performance = walking aids, oxygen equipment If using oxygen, maintain usual flow rate & keep constant during test = DO NOT TITRATE 7Identify one exception for applying oxygen during test if not used routinely = if patient desaturates to 85% or less on room air after 10 min rest 8Position 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 oximeter to provide continuous O2 sat data during walkNo warm-up is needed DURING 6MWT 9Discuss the importance of following a standardized procedure for test performance for test to help assure reproducibility 10Perform pre-test measurements: Heart rate, BP, & O2 saturation Dyspnea level & fatigue level (Borg 0-10) 11Explain that this is a self-paced walking test for the purpose of seeing HOW FAR a person can walk in 6 minutes time 12Read ATS scripted instructions to each patient for each test 13Demonstrate correct walking technique such as: Where to walk out & back How to go around cones without slowing down And so on 14Select a mid-point along the path to stand for best observation & coaching, including visualization of oximeter data as patient passes by 15Give rationale for NOT walking with patient, unless there is a safety issue or fall risk = if needed, walk behind patient to not influence their pace 16.Provide scripted instructions every 1 minute during test = DO NOT use other words of encouragement 17Allow patient to stop & rest if needed = lean against wall or sit down, but clock keeps ticking 18When stops occur, use scripted instruction every 30 seconds to “please resume walking whenever you feel able” Note time stopped & when re-started19Monitor O2 sat & HR each time patient passes therapist’s position Without interrupting walking pace, have patient hold up hand to see oximeter data when passing by20React immediately to stop test if/when O2 sat drops to 80% or less = new cut-off value 21As 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”. 22At 6 minutes, go to patient’s side to:Obtain HR & O2 sat data Take blood pressure Ask RPD & fatigue ratings Ask why they could not walk any farther POST 6MWT 23Have patient sit in chair & relax for 5-10 minutes 24Complete test documentation including Total distance walked Number & length of stops Lowest O2 sat & highest RPD observed during test Signs/symptoms reported Reason could not go farther 25Translate total distance walked into mph & METs to help with starting exercise training on the treadmill 26At entry walk, continue with other admission assessments & repeat walk at end of visit (at least 30 minutes later) 27Explain that rationale for 2nd walk test ton same day is to allow for patient’s learning curve & provide opportunity for improvement in performance Use best result (longest distance) of 2 initial tests as outcome data 28Describe 2 types of exceptions to repeating the walk test a second time:Patient who does quite well the first time = unlikely to do betterPatient who is quite sick & struggles to complete first walk = unable to walk again29At exit walk, compare results to entry walk data & explain extent of change to patient 30Explain that rationale for only 1 walk at exit is because patent is now familiar with the 6MWT procedure 31State that a clinically significant change from entry to exit test is 30 meters/100 feet = 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. Instruction/demonstration session by an RT experienced in 6’ walk studies Practice & return demonstration to each other Observation of an actual test on a PR patientCross-reference to: AACVPR Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals. JCRP 2014; pg 298, Exercise Testing: Knowledge bullets 1-5 & Skills bullets1 & 4. Evaluation: Signature _______________________________ Date ________________ ** any/all ratings of Inadequate require a corrective action plan tailored to the staff member involved ................
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