presented by Rebecca Crouch
There is a significant need for pulmonary rehabilitation therapy across the country. Chronic lower respiratory disease is the third leading cause of death in the United States. There are approximately 30 million people in the United States who have been diagnosed with COPD. The state-wide prevalence of Chronic obstructive pulmonary disease (COPD) ranges from a low of 3.9% to a high of 9.3%. The Southeastern U.S. has been particularly vulnerable to the disease due to the higher use of tobacco products and agricultural/industrial exposures. Pulmonary rehabilitation therapy is an important component of total care for any patient with chronic respiratory disease and is thought to provide the greatest improvement in symptoms, exercise capacity, and health-related quality of life of any therapy available for patients with COPD. Physical therapists have unique skills to deliver exercise therapy to the pulmonary population. In addition to deconditioning, these patients are also known to have muscle weakness, postural abnormalities, and balance impairments that respond very well to physical therapy intervention.
Dr. Rebecca Crouch has practiced cardiovascular and pulmonary physical therapy in the acute care and outpatient rehabilitation settings, and was a founding member and director of the Duke University pulmonary rehabilitation outpatient program for 30 years. She is now an assistant professor in the Doctor of Physical Therapy program at Campbell University, and her clinical practice is in acute care at Duke. She has written numerous publications and given presentations in the areas of pulmonary rehabilitation, oxygen management for physical therapists, evaluation and exercise for the cardiopulmonary transplant and medical pulmonary populations, and outcomes measurement. Dr. Crouch has been involved in several professional organizations, including the American Physical Therapy Association (Cardiovascular and Pulmonary Section), American Thoracic Society (state and national), and the American Association of Cardiopulmonary Rehabilitation and Prevention. Dr. Crouch is a business partner in PT Cardiopulmonary Educators, a webinar-based educational service, and is CEO of Cardiopulmonary Therapy Resources, a cardiopulmonary consulting business.
Chronic lung disease is the third leading cause of death in the United States. Risk factors are associated with lung diseases. Therapists should be familiar with these risk factors so that targeted educational topics can be incorporated into the treatment process.
Who are the patients that will benefit from pulmonary physical therapy? This section will note the diagnoses that are appropriate for pulmonary rehabilitation and the physical impairments that are common.
The physical therapist must have an evaluation template for lung disease patients. This section will highlight the important components of a comprehensive pulmonary therapy evaluation and explain why they are different from a typical PT evaluation.
The therapist will have a choice of outcome measures that are relevant to the pulmonary rehabilitation population. The recommended outcomes reviewed will be impairment based and outpatient focused.
It is important to have a thorough understanding of the guidelines for oxygen therapy, equipment options, and titration with rest and activity. The physical therapist must evaluate the patient’s need for oxygen, current oxygen equipment if already on oxygen therapy, and the equipment's ability to adequately meet the saturation guidelines.
Based on evaluative findings, targeted treatment programs and goals can be designed for various pulmonary rehabilitation patients. These treatment components will highlight basic physiological principles and those unique to the pulmonary population. Recommended goals will be realistic and emphasize a change in lifestyle.
Documentation components and billing codes will be discussed to meet reimbursement requirements of pulmonary rehabilitation therapy by Medicare and private insurance. It is crucial for the physical therapist to have a thorough understanding of specific billing codes accepted by all third-party payers, and the specific codes to use with differing pulmonary diagnoses.