JISCMail - PHYSIO Archives

Yes, you need to use the RPE scale for heart transplants patients. I think you're right about Nancy using the RPE 0-10 scale. The original Borg Score had numerical values from 6 to 20 with descriptions from very, very light to very, very hard placed against 7 of these numbers (this is the one you and I use). The modified borg score (1982) is used to assess perceived breathlessness in response to an intervention such as exercise. Words range from 'nothing at all' to 'maximal' and are next to values 0-10. (ref Practical Pulmonary Rehabilitation by Mike Morgan and Sally Singh .... the only text book I happened to have on my desk at the time).I don't know much more about the differences between the 2 scores but I guess this would be a good area to read up on. I think a fair bit of research has been done on the correlation between physiological response and RPE score.

I think hypersensitivity over the scar is quite common, especially in patients who have had the left internal mammary artery used..... don't quote me on that, I'm not a cardiac rehab specialist. Perhaps our musculo-skeletal physio colleagues will have some tips on how to treat that.

Your 'gung-ho' type: yes, I have had such transplant patients. I suppose you can only advise them, gently at first and then more strongly. Make a point of explaining to him that his heart rate cannot increase to meet the demand he is putting on it and that is why he gets very breathless when he pushes himself too hard.

How long post transplant is he? We do let our more responsible patients increase their own work-load on the treadmill, as long as they understand how hard they should be working and how to progress their exercise. Don't forget that (unlike you M.I. patients), he has gone from having a failing heart to a strong new one, so he should be increasing his fitness more rapidly than your M.I. patients unless there have been problems with the new heart. If you feel that he is really being irresponsible and doing too much you could voice your concerns to his transplant cardiology consultant, or if worst comes to worst, tell him you are not willing to take responsibility for his exercising in the gym under your care if he will not abide by your guidance.