Physiotherapy in Cardiovascular and Respiratory Conditions

Anatomy and physiology of respiratory and cardiovascular systems.

Assessment and prescription of specialized interventions in respiratory and cardiovascular cases

Clinical reasoning oriented to maximize functioning.

Teaching methodologies include:

Presentation: to present the issues / content, raise problems and guide the approach of students; Use of different cases to illustrate the topics under study;

Discussion in small groups of clinical cases. To this end, students will have to resort to research, reading and problem solving to critically analyze and select appropriate physiotherapy assessment and intervention methods and techniques for patients with cardiovascular and respiratory pathologies. Construction and discussion of clinical cases including their evaluation, clinical reasoning, determination of smart objectives, intervention and reassessment strategies and plans. Flip-based learning.

Practical-instrumental (psychomotor performance);

Cognitive: reflective mental performance and knowledge;

Affective: growth of emotional/behavioral and attitude areas.

After completing the curricular unit, the student should know, understand and be able to:

Apply the principles of assessment, diagnosis, programming and intervention in conditions and problems associated with the cardiovascular and respiratory system, as well as to elaborate adequate records, based on Functionality/Disability;

Organize the elements associated to Physiotherapy procedures according to the components Structures, Functions, Activities/Participation and Contextual Factors

Develop strategies centered in the education/counselling of patients/patients and relatives and of the knowledge of the contribution of the different members of the health team so that the physiotherapist has a global vision of the patient/user

Critically analyze the models and practical strategies in the different contexts where the physiotherapist works

Evaluate the evidence of practice in the context of cardiovascular and respiratory conditions.

1. Examination and assessment of Functionality and Disability components (body structures and functions, activities and participation) and Contextual Factors in cardiovascular and respiratory conditions 

2. Determination of prognosis in cardiovascular and respiratory conditions

                 Definition of expected smart goals;

                 Frequency and duration of sessions;

                 Factors that may influence the sessions and intervention plan;

3. Approaches based on evidence and focused on the patient/client with cardiovascular and respiratory conditions

                 New technologies, including Assistive Technologies and artificial intelligence

                 Health promotion and prevention of secondary problems;

                 Education and counseling;

                 Community-based rehabilitation;

                 Telerehabilitation

NAO

Principal Bibliography

Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C,
Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P,
Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler AO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020 Mar 30:2047487320913379. doi:10.1177/2047487320913379. Epub ahead of print. PMID: 32223332.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 10th edition, 2018;

APFisio. “Registo, logo existo!”: Registo Clínico de Fisioterapia, 2018. Disponível em: http://www.apfisio.pt/wp-ontent/uploads/2018/10/RLE__2018_008_31__Registo_logo_existo.pdf

Secondary Bibliography:

Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C,
Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P,
Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler AO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020 Mar 30:2047487320913379. doi:10.1177/2047487320913379. Epub ahead of print. PMID: 32223332.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 10th edition, 2018;

APFisio. “Registo, logo existo!”: Registo Clínico de Fisioterapia, 2018. Disponível em: http://www.apfisio.pt/wp-ontent/uploads/2018/10/RLE__2018_008_31__Registo_logo_existo.pdf

Bibliografia Secundária

– Chartered Society of Physiotherapy. Inspire Respiratory Guidelines. 2015;

– Dowman L, Hill CJ, May A, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021 Feb 1;2(2):CD006322.

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor. RS. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016;67(1):1–12

Anderson L, Nguyen TT, Dall CH, Burgess L, Bridges C, Taylor RS. Exercise-based cardiac rehabilitation in heart transplant recipients. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012264. DOI: 10.1002/14651858.CD012264.pub2. Accessed 13 May 2021.

Atkinson HL & Nixon-Cave K. A Tool for Clinical Reasoning and Reflection Using the International
Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model. Physical Therapy, 2016;91(3):416-430.

Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(SUPPL. 1).

Calabrese M, Garofano M, Palumbo R, Di Pietro P, Izzo C, Damato A, Venturini E, Iesu S, Virtuoso N, Strianese A, Ciccarelli M, Galasso G, Vecchione C. Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art. Life (Basel).2021 Mar 21;11(3):259. doi:10.3390/life11030259. PMID: 33801080; PMCID: PMC8004041.

Chartered Society of Physiotherapy. Inspire Respiratory Guidelines. 2015 

Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med [Internet]. 2018;136
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Consortium for Spinal Cord Medicine. Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(3):259-93. doi:
10.1080/10790268.2005.11753821. PMID: 16048145.

Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen G. Clinical Reasoning Strategies in Physical Therapy. Physical Therapy 2004 April;4(84):312-330;

European Society of Cardiology. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal, 2017; 00: 1–60. https://doi.org/10.1093/eurheartj/ehx391.

eviCore healthcare. SMART Goals in Physical and Occupational Therapy: Overview, Writing Tips, and Resources. 2018. Disponível em: https://www.securityhealth.org/-/media/Provider/S-M-A-R-T-GoalsOverview-Writing-Tips-and-Resources_PT-OT-FINAL.pdf.

Global initiative for chronic obstructive lung disease. 2023 report.

Gloeckl R, Zwick RH, Fürlinger U, Jarosch I, Schneeberger T, Leitl D, et al.. Prescribing and adjusting exercise training in chronic respiratory diseases – Expert-based practical recommendations. Pulmonology. 2022 Oct 20:S2531-0437(22)00215-X

Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2008 Sep;89(9):1782-7

Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Stuart Elborn J, Andres Floto R, et al. British thoracic society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1).

Hoffman M, Chaves G, Ribeiro-Samora GA, Britto RR, Parreira VF. Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review. BMJ Open. 2017 Feb 3;7(2):e013445

Holland AE, Cox NS, Houchen-Wolloff L, Rochester CL, Garvey C, ZuWallack R, et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2021 May;18(5):e12-e29.

Jette D, Ardleigh K, Chandler K, McShea L. Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral. Physical Therapy, 2006;12(86):1619-1629;

Jenkins S, Hill K, Cecins NM. State of the art: how to set up a pulmonary rehabilitation program. Respirology. 2010 Nov;15(8):1157-73
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews, (2).

Reid WD; Chung F; Hill K. Cardiopulmonary physical therapy: management and case studies. 2nd ed. Slack Incorporated, 2014;

Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al.; ATS/ERS Task Force on Policy in Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1373-86.

Steiner WA, Ryser Huber L, et al. Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine. Physical Therapy, 2002;82(11): 1098-1107;

Spruit MA, Wouters EFM. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology. 2019 Sep;24(9):838-843

WHO. ICF Browser. Disponível em: https://apps.who.int/classifications/icfbrowser/