By Denise Williams, News & Views staff
CR and PR professionals who are interested in remote rehab can unlock a wealth of information and expert perspectives with AACVPR’s newly curated collection of webinars. The association is pleased to offer the Virtual Cardiac and Pulmonary Rehabilitation Module Series, presented in easy-to-digest segments of 10 to 30 minutes. The offering begins with presenters walking users through the fundamentals of evidence-based practice and wraps up with several case studies that reflect how virtual CR and PR have been used successfully in a variety of settings.
Kariann Drwal, CCRP, and Hank Wu, MD, MPH use their allotted time, for example, to showcase the Department of Veterans Affairs’ remote rehab programs. Drwal collaborated with a nurse—Bonnie Wakefield, RN, PhD—to launch VA’s virtual CR program in 2010, followed by the virtual PR program in 2017. The impetus, she explains, was to widen access for the nation’s veterans, whose barriers include financial limitations and/or lack of transportation. What remote rehab allows practitioners to do, according to Drwal, who oversees implementation of the model to other VA sites nationwide, “is to meet those patients in the home and try to empower them by providing the tools to self-manage their disease, preparing them to make the necessary behavioral changes, and motivating them to continue past the rehab program after we’re done.”
The March issue of the Journal of Cardiopulmonary Rehabilitation and Prevention featured an article on the program, which was shown to have fairly high completion rates versus center-based models, with significant improvements in exercise and lower rates of depression from baseline to completion.
While the VA model was obviously designed with veterans in mind, Drwal notes that plenty of patients are still actively involved in the workforce. Taking off multiple times a week for rehab is another barrier that a remote format can break down. The same can be said, she adds, for rural residents as well as for patients who are taking care of other people—whether a spouse or a grandchild—and cannot come and go freely as a result. Yet another vulnerable population who stands to benefit from remote rehab are people who shy from the group setting, perhaps because of a mental health disorder or another reason.
Practitioners who take advantage of the bundle will find that it’s a great place to learn about the background of virtual CR and PR, says Drwal. “Along with the importance not only during COVID, where we need to try to provide alternative models, we all know the research that there’s just not enough programs to serve all of our patients who need CR or PR,” she remarks. “To be able to offer these models, also with our traditional models we already have, should help promote and increase referrals to and participation in these programs, which are so vital in patients’ treatment and recovery.”
Beyond VA Care
In between the introduction and the case studies, our speakers dive into a comprehensive range of specific topics, from Patient Assessment and Risk Stratification to Psychosocial Management and Billing. The heading of Risk Factor Management and Education is especially jam-packed—including discussion on virtual delivery of patient education, tobacco cessation, oxygen use, and exacerbation prevention and management, among other subject matter.
Meanwhile, in a webinar titled “Adherence to Medications, Lifestyle and Long-Term Exercise,” several other key components of virtual delivery take center stage. In the 30-minute presentation, registered dietitian Ruth Rasmussen, MA, MS, RDN, CCRP and psychologist Amy Knight, PhD, ABPP turn the focus to behavior and nutrition strategies for sustainable cardiac health. The talk also touches on medication adherence, accelerating weight loss, and other important aspects, but the core subject is nutrition. This is important, Rasmussen emphasizes, because while most programs are very strong in the area of goal-setting and understand the roles of exercise and behavior, not many actually have a dietitian on staff.
With this in mind, Rasmussen says, her discussion leans heavily toward guidelines and standards—particularly those set by the American Heart Association—on sodium, saturated fat, cholesterol, sugar, and fiber. She presents the info in real-life detail. For example, AHA guidance aims to lower saturated fat to less than 6%; in practical terms, Rasmussen says a single slice of bacon comes close to that limit, so a breakfast including bacon every morning isn’t going to work. Similarly, AHA’s cholesterol limit is 200 milligrams per day—or the equivalent of one egg yolk. With these kind of comparisons, Rasmussen hopes that people can gain a clear-cut understanding of what the guidelines mean in real life. Knight ties it all neatly together, meanwhile, with some insight on behavior management to help put that knowledge into play.
After completing this section of the module series, Rasmussen believes users will achieve “strong clarity” on nutrition and dietary standards. “But they should also walk away with some specific ideas on how they can guide their patients,” she continues. “When they talk to patients and someone has indulged in some fat foods, hopefully they can point out some other foods” as a substitute.
Not Just Talk
In addition to the practical knowledge users will glean from the various modules, the bundle also includes supplemental materials. Sample protocols for incorporating home-based rehab and sample telephone and video scripts are among some of the resources found in the virtual “goodie bag.” Users additionally will be eligible for AACVPR, ANCC, AARC, and ACSM credits.
AACVPR members may access the recordings at no cost thanks to the generous support of Chanl Health and Phas3 Health, while non-members pay just $375.