Level 4 Pulmonary Rehabilitation
Assessment Guidance & Documentation
The key email address is Case Studies for anything associated with externally delivered courses. Please note: For extension requests or queries regarding assessments please contact Case Studies.
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Additionally, lecturing staff is not permitted to preliminary grade papers prior to submission. All communication should be made directly to the WRIGHT Foundation Office and any requests to review students' work will be declined.
On Course Resources
Below is an array of resources that will provide with additional support and guidance necessary to aid you you passing this Level 4 Pulmonary Rehabilitration.
Pulmonary Rehab
Quizzes
This is a 30 question quiz that has been constructed in a random order.
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This is a 30 question quiz that has been constructed in a random order.
Online Physiology Resources
Click the image to access this information about free retraining courses.
Online Bitesize Media
On Course and Discussion Links/Notes
Below are links to relevant information that was discussed during each course day. There are numerous academic studies and resources in the area of specific exercise prescription and programming.
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Online Asthma & COPD Resources
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American Association for Cardiovascular and Pulmonary Rehabilitation: http://www.aacvpr.org​
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American Lung Association: http://www.lungusa.org/lung-disease/copd/
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EPR3: Guidelines for the Diagnosis and Management of Asthma (Expert Panel Report 3): http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
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CTSNet. Goodbye Sternal Precautions, Hello Move in the Tube? https://www.ctsnet.org/article/goodbye-sternal-precautions-hello-move-tube
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Global Initiative for Asthma: http://www.ginasthma.org​​
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Organisations & Qualifications Links
Additional Resources, Journals, Studies, and Recommendations for Long COVID, and Physical Activity
Resources
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Your COVID Recovery [Guidance on all steps on recovery from covid-19, including nutrition and physical activity] - Link
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COVID-19: Supporting your recovery [ Developed by Lancashire Teaching Hospitals, a resource with all aspects of rehabilitation after covid-19] - Link
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Chartered Society of Physiotherapists. Covid-19: the road to recovery [Guidance on a graduated return to physical activity after covid-19] - Link
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World Health Organization. Support for rehabilitation self-management after COVID-19-related illness [Advice for those who have been discharged from hospital with covid-19, including breathing exercises and physical activity] - Link
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Academic Studies
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Polero, P., Rebollo-Seco, C., Adsuar, J.C., Pérez-Gómez, J., Rojo-Ramos, J., Manzano-Redondo, F., Garcia-Gordillo, M.Á. and Carlos-Vivas, J., 2021. Physical activity recommendations during COVID-19: narrative review. International journal of environmental research and public health, 18(1), p.65. Link
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Kılıç, A., Erkalp, K. and Darıyerli, N., 2022. Physiology of Exercise and Its Importance During COVID-19 Pandemic. Link
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Wunsch, K., Kienberger, K. and Niessner, C., 2022. Changes in physical activity patterns due to the COVID-19 pandemic: A systematic review and meta-analysis. International journal of environmental research and public health, 19(4), p.2250. Link
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Jimeno-Almazán, A., Pallarés, J.G., Buendía-Romero, Á., Martínez-Cava, A., Franco-López, F., Sánchez-Alcaraz Martínez, B.J., Bernal-Morel, E. and Courel-Ibáñez, J., 2021. Post-COVID-19 syndrome and the potential benefits of exercise. International journal of environmental research and public health, 18(10), p.5329. Link
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Salman, D., Vishnubala, D., Le Feuvre, P., Beaney, T., Korgaonkar, J., Majeed, A. and McGregor, A.H., 2021. Returning to physical activity after covid-19. bmj, 372. Link
Case Study & Practical Resources
Guidance Notes on the Case-Study Report : post-course written assessment.
To be completed post-course and is based on a ‘hypothetical’ client. Candidates have 12 weeks to complete this assessment and return it to the office. Pass Mark = 70%. per section.
Below is a list of resources that may help you to complete the case study. Each resource underneath has a brief description of its use. Additionally, there is a large body of information that will allow you to implement it within your own professional practice.
Case Study Summary Guidance
You MUST complete the following steps [Use the Case Study Template Above]:
Section 1 - A summary of your client’s medical history and current medical status.
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Section 2 - Details of any medication your client may be taking, including the reason for taking the medication, the effect, the potential side effects, and the implications for exercise prescription.
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[Table Template > Link; Completed Table Example on Pharmacology Agents and Considerations with Exercise > Link]
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Section 3 - Provide statements of the appropriate clinical objectives. Each objective must be accompanied by the underlying reason, or multiple reasons, for selection.
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Section 4 - A twelve-week exercise/rehab plan including gym-based interventions and others.
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Example of a partially completed 12-week Overview > Link
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Section 5 - Justify each intervention by explaining the specific and/or general responses/adaptations to that exercise.
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Section 6 - Consider all psychological issues you feel are relevant in dealing with your client, in order to effect positive lifestyle change(s) and provide details of which behavioral strategies you feel would be appropriate.
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[ACSM Resource to Help Generate Evidence For Section 6 > Link; ACSM’s Behavioral Aspects of Physical Activity and Exercise Chapter 2 > Link]
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Section 7 - A summary of pre-post physiological measurements with a rationale for each measurement and, where appropriate, a rationale for not taking a specific measurement.
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[Example Template> Link]
Section 8 - An information sheet suitable for your lay client (one side A4) giving advice on generally positive lifestyle changes regarding his/her specific condition
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Section 9 - A plan of how you would engage the help of, or offer your services to, the local NHS/PCT to form a multidisciplinary team in pulmonary disease management.
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[This resource will help generate answers for Question 9 - Kuzma, A.M., Meli, Y., Meldrum, C., Jellen, P., Butler-Lebair, M., Koczen-Doyle, D., Rising, P., Stavrolakes, K. and Brogan, F., 2008. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 5(4), pp.567-571. Link ]
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Referencing Help & Support - Download Guide
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If you are struggling with how to reference and write an academic piece of the work please review the document above for guidance.
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Case Study Resources
NHS Medication Resource [Case Study Relevant]
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[Use this resource for section 2] NHS Medication - Link
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Mental Health Measurement & Tools [Case Study Relevant]​
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About this document - The Generalised Anxiety Disorder Assessment (GAD-7) is a seven-item instrument that is used to measure or assess the severity of generalized anxiety disorder (GAD). Each item asks the individual to rate the severity of his or her symptoms over the past two weeks. Response options include “not at all”, “several days”, “more than half the days” and “nearly every day”.
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About this document - The PHQ-9 is the nine-item depression scale of the patient health questionnaire. The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. The PHQ-9 can function as a screening tool, an aid in the diagnosis, and as a symptom tracking tool that can help track a patient's overall depression severity as well as track the improvement of specific symptoms with treatment
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Warwick-Edinburgh Mental Well-being Scale (WEMWBS) - Link
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About this document - WEMWBS is a 14-item scale of mental well-being covering subjective well-being and psychological functioning, in which all items are worded positively and address aspects of positive mental health. The scale is scored by summing responses to each item answered on a 1 to 5 Likert scale. The minimum scale score is 14 and the maximum is 70. WEMWBS has been validated for use in the UK with those aged 16 and above. Validation involved both student and general population samples, and focus groups.
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Short General Health Questionnaire (GHQ 12) - Link
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About this document - The General Health Questionnaire (GHQ) is a screening device for identifying minor psychiatric disorders in the general population and within the community or non-psychiatric clinical settings such as primary care or general medical out-patients. Suitable for all ages from adolescents upwards (but not children), it assesses the respondent’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term psychiatric disorders but not to long-standing attributes of the respondent.
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Development of a Self-Reported Chronic Respiratory Questionnaire (CRQ-SR) - Link
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About this document - The aim of this study was to develop a standardized and externally paced field walking test, incorporating an incremental and progressive structure, to assess functional capacity in patients with chronic airway obstruction.
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Physical Resources & Tools [Case Study/ Practical Assessment Relevant]
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PARQ+ (2021) - Link
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About this document - The PAR-Q+ is a 7-step questionnaire for use with persons of all ages. It screens for evidence of risk factors during moderate physical activity and reviews the family history and disease severity. If a person answers yes to one or more questions, the individual should complete a thorough follow-up of medical questions and consult a physician about beginning physical activity. An interactive online version for medical follow-up questions is provided by the e-PARmed-X+ (Jamnik, et al, 2011; Bredin, et al, 2013).
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About this document - The SGRQ questionnaire has 50 items with 76 weighted responses. It has good discriminative and evaluative properties and is responsive to therapeutic trials. It was developed and validated in both asthma and COPD, although it has also been validated for use in bronchiectasis, interstitial lung disease, post tuberculosis lung, pulmonary hypertension, pulmonary leiomyomatosis, and sarcoidosis. There is a large literature concerning the use of the questionnaire in many settings, including normal values. It takes 8-15 minutes to complete and is best scored using a computer. The SGRQ is the best thought of as a research or audit tool.
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St. George’s Respiratory Questionnaire Application - Link
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About this document - This software calculates scores derived from the St George’s Respiratory Questionnaire (SGRQ) and the SGRQ-C. The SGRQ has been validated in COPD, asthma, and several other respiratory diseases. The SGRQ-C has been developed using COPD data, and has not yet been validated for other diseases, but is likely to perform similarly to SGRQ.
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About this document - The original scale was developed in healthy individuals to correlate with exercise heart rates (e.g., RPE 15 would approximate an HR of 150 bpm), and to enable subjects to better understand terminology (Borg, 1982). The category ratio scale was later developed and has since also been modified to more specifically record symptomatic breathlessness (Modified Borg Dyspnoea Scale). RPE scales are particularly valuable when HR measures of exercise intensity are inaccurate or dampened, such as in patients on beta-blocker medication. This is due to the scale’s ability to capture the perceived exertion from central cardiovascular, respiratory and central nervous system functions (Borg, 1982).
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Various Online Calculators - Link
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1RM Estimate Calculator - Link
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RPE Chart - Link
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Talk Test Chart - Link
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Example of a generalized RAG Progression Circuit [Red, Amber & Green] - Link
Other Tests of Muscular Fitness for Individuals with Chronic Lung Disease
About these documents - There are several validated physical function tests in senior adults that may be used to assess upper and lower muscular strength and endurance in PR populations. Testing is performed at program entry and periodically thereafter for assessment of individual improvement or decline. Upper and lower body muscular power (e.g., watts) may be assessed from some of these tests. These types of tests include, but are not limited to, the following:
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Six-Minute Walk Test - Link
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Original Study - Link
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ATS Statement: Guidelines for the Six-Minute Walk Test - Link
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Media of the Six-Minute Walk Test - Link
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About this document - The six-minute walking test (6MWT) was developed by the American Thoracic Society and it was officially introduced in 2002 [orginally developed by Singh et al., 1992], coming along with a comprehensive guideline. The 6 Minute Walk Test is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity.
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The incremental shuttle walk test (ISWT) was developed to simulate a cardiopulmonary exercise test using a field walking test.
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About this document - The endurance shuttle walk test (ESWT) is a constant-load exercise test that measures the ability of the participant to sustain a given sub-maximal exercise capacity. The ESWT speed is calculated based on the protocol developed by (Revill, et al., 1999), (Hill, et al., 2012) 10, and (Wootton, et al., 2014) and is performed according to the original protocol. Two ESWTs are performed to account for any learning effect. The endpoint of the test is how long the participant walks at a constant endurance speed. The test consists of 8 tracks that are pre-recorded with a signal at different frequencies giving a total of 16 walking speeds.
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Timed Up and Go (TUG) test – Link
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About this document -The Timed Up and Go test, also known as the TUG test, is a simple evaluative test used to measure your functional mobility. It is most often used in physical therapy to give your therapist an idea of how safely you can move around. The TUG test can also be used by your healthcare provider to estimate your risk of falling and your ability to maintain balance while walking.
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Five-Times-Sit-To-Stand test – Link
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Sit-to-stand tests for COPD: A literature review - Link
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Whitney et al., (2005) Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test - Link
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About this document - The Five Times Sit to Stand Test (5x Sit-To-Stand Test) is commonly abbreviated as 5XSST. Used to assess functional lower extremity strength, transitional movements, balance, and fall risk in older adults.
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30-Second Chair Stand test – Link
About this document - The 30 Second Sit to Stand Test also known as the 30-second chair stand test (30CST), is for testing leg strength and endurance in older adults. It is part of the Fullerton Functional Fitness Test Battery. This test was developed to overcome the floor effect of the five or ten repetitions of sitting to stand the test in older adults.
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30-Second Arm Curl test – Link
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About this document - The Arm Curl test is a test of upper body strength, and is part of the Senior FitnessTest (SFT) and the AAHPERD Functional Fitness Test, and is designed to test the functional fitness of seniors. There are slight differences between the protocols for the Senior and AAHPERD tests, such as the weight used for women. The differences are indicated below. See also the maximum bicep curl test.
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6-Minute Pegboard and Ring test – Link
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About this document - The 6-minute pegboard and ring test (6PBRT) was developed to evaluate arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients.
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The gallon jug shelf transfer test – Link
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About this document -The GJST is a valid, reliable, inexpensive, safe, and easily administered clinical test for identifying physically vulnerable elders who could benefit from interventions such as exercise to improve their physical capacities and maintain independence.
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Although normative data currently do not exist for many of these tests for individuals with chronic lung disease, published normative values may provide a reasonable reference point to determine the rate of improvement (or decline) over time. These data may also show the client how they compare to others in their particular age category. Consideration must be given to the severity and type of lung disease, comorbidities, musculoskeletal abnormalities, and hypoxemia with a regular subjective and objective assessment of these types of tests. Until these (and other) muscular fitness tests have been validated in pulmonary populations, test results should be viewed with caution when comparing normative values to geriatric populations.
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ACSM and Other Exercise Recommendations
Below are the most up-to-date exercise recommendations for individuals with various conditions [i.e., Asthma and COPD]. These resources can be used to provide information that will allow you to correct construct individual client-centered exercise sessions.
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ACSM (2021) FITT Key Recommendations for Individuals with Asthma - Link
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ACSM (2021) FITT Key Recommendations for Individuals with COPD - Link
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Clinical Exercise Testing Recommendations, Procedures, and Guidelines for the COPD Client - Link
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Pharmacology Treatments and Considerations with Exercise (including Agents Available in the USA and the UK) - Link
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Table of the Various Components of the Services Offered in Pulmonary Rehabilitation - Link
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The e-Book developed below contains information from the recommendations established by ACSM (2021) guidelines.
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Observation Clips and Resources
[Click the image to the right for the observation booklet]
These YouTube clips may be used to complete the above observation booklet.
Please Note: All evidence or questions should be sent to the following address and NOT the Lecturers.