After I read the article by CHARLES W. CORTES, I felt that I should comment on it
reflecting my experience at our acute care hospital (2nd largest heart surgery
center in Philadelphia reagion).
[log in to unmask] wrote:
> The April edition of the on-line The Journal of Exercise Physiology featured
> an interesting and controversial article on the entire concept of exercise
> prescription for cardiac rehabilitation at the following website:
>
> http://www.css.edu/users/tboone2/asep/jan4.htm
>
> This article concluded:
>
> "There is a negative side to implementing exercise rehabilitative sessions
> without medical supervision. If coronary artery disease is not cured by
> exercise, which it is not, then exercise with this disease can certainly
> predispose the patient to a
> life-threatening crisis.
Yes, exercise does not cure disease, but why can't we make exercise to reduce
life-thretening crisis. I believe that current cardiac rehab program is to
medically supervise and guide poeple who experienced cardiac condition to improve
their quality of life and reduce the risk associated with their exercises.
> This logic, although not agreed upon by many
> contemporary specialists in the field, extends across the spectrum of cardiac
> patients (whether low, moderate, or high risk for cardiovascular
> complications).
>
> There is also a negative side to paying the high charges for exercise sessions
> (either with or without ECG monitoring). These rising costs represent the most
> logical means by which program directors waste little time in increasing their
> revenue. However, if the charges continue to rise without serious
> documentation of need or the likelihood of meeting the program outcomes, one
> could expect these services to be gradually reduced in the years to come.
>
> In summary, we are convinced that it is not right to put the cardiac patient
> at risk (however slight, such as during unsupervised exercise) just because
> insurance carriers will pay for the sessions.
I agree that the exercise sessions are very expensive. Most of our patients will
decline services if there is no insurance coverage. However, we never utilize our
services solely according to the insurance coverage. We discharge people when they
are stable and understand proper exercise parmeters, risk modifications, stress
management, and diet.
|We also disagree with the notion
|that any health professional is adequately educated to provide care during the
|design and implementation of the exercise prescription (as exercise
|physiologists are trained).
This may be true, therefore, each cardiac rehabilitation center must train staff
according to ensure the safety of the patients. How do we do that? ACLS is a
must, Exercise specialist certification, each professional organization's
specialization certification are valuable. It seems advantageous to have
multidisciplinary staff in the team, so that different view points regarding
health will be addressed.
I am a physical therapist by training, so I continue to learn from MDs, nurses and
exercise physiolosits. In return, I can offer information and skills regarding
comorbidities, such as muscular dystrophy, MS, amputee, CVA,DJD, etc...
> Clearly, while some gains in cardiac rehabilitation are obvious, the subtle
> but definite changes from proven standards and protocols appear to put the
> welfare of the patients at risk. In light of these remarks, it seems apparent
> that cardiac rehabilitation specialists should re-evaluate the concept of
> "quality care."
>
> These specialists should also collect and analyze data of all unsupervised
> patients and correlate risks against costs. Above all, new developments in
> cardiac rehabilitation, particularly exercise rehabilitation, must be
> adequately and scientifically researched before financial incentives takes
> precedent over patients' safety".
> ------------------------------------------------------------
>
> Comments from anyone about this article?
>
> Dr Mel C Siff
> Littleton, Colorado, USA
> [log in to unmask]
If you have any comments or questions to this response,
Sachiko Komagata,PT
Havertown, PA USA
[log in to unmask]
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