What are the functional assessment criteria for cardiovascular disease?

1. Clinical examinations and motor function assessment

(1) Clinical examination

Through blood routine, erythrocyte sedimentation rate, myocardial enzyme spectrum, blood pressure, resting electrocardiogram, 24-hour dynamic electrocardiogram Through examinations such as echocardiography and vector cardiogram, occupational therapists can observe and understand the patient's condition changes and cardiac function status, and classify cardiac function (Table 13-3-1). In addition, attention should be paid to the monitoring of risk factors for coronary heart disease (Table 13-3-1). Such as blood pressure, blood sugar, blood lipids, etc.)

Table 13-3-1 Cardiac function classification standards

(2) Motor function assessment

As the patient’s activity ability improves , low-level ECG exercise tests are acceptable. When entering the II-III rehabilitation period, metabolic equivalents of symptom-limited ECG exercise tests should be measured regularly as a basis for occupational ability assessment and occupational therapy plan formulation and efficacy observation. Due to exercise intensity and exercise endpoints They are all limited to the patient's ability. Therefore, the safety of the exercise test itself is good. Currently, there are no reports of serious accidents. In addition, the hemodynamic response to dynamic exercise and the cardiopulmonary response to isometric exercise (involving this) can also be measured. For specific methods, please refer to "Rehabilitation Therapy Assessment Science")

(3) Cardiovascular risk classification

Grading the risk of cardiovascular diseases such as acute myocardial infarction can be used as a The basis of physical therapy occupational therapy and medical and surgical treatment is divided into low, medium and high-risk patients based on objective indicators such as clinical manifestations and examinations. Low-risk patients do not require electrocardiogram (ECG) monitoring and close exercise monitoring, including energy consumption after simple coronary artery recanalization gt ; 7.5 METs (3 weeks after ischemic attack), no myocardial ischemia, left ventricular dysfunction, serious arrhythmia; intermediate-risk patients only need intermittent ECG monitoring, including energy consumption 15mmHg) or ischemic ST segment depression gt; 2mm, low Magnitude exercise-induced myocardial ischemia or sustained ischemia after exercise, sustained ventricular arrhythmia (spontaneous or induced)

Second work ability assessment

(1) Cardiac arrhythmia Assessment of the disability level of patients with vascular disease

Cardiovascular disease leads to abnormalities in the patient's overall comprehensive living ability. The functional disability caused by cardiovascular disease is assessed from the patient's overall level, focusing on the patient's basic daily life. The ability of living activities is assessed, that is, whether the patient can live a completely independent life individually. If the patient suffers from angina pectoris or palpitation, shortness of breath and difficulty in breathing even after a little movement, it may affect the patient's daily life such as dressing, eating, grooming, bathing, going to the toilet, and defecating. To successfully complete life activities, you need the help of others, let alone go out shopping independently, participate in various social activities, and professional activities that require a certain level of mobility. There are many ways to evaluate the ability of daily living activities, and the Pap index is usually used. and functional independence measurement

It should be noted that the pathological changes caused by cardiovascular disease itself and the degree of cardiac function damage have inconsistent effects on the ability of daily activities of different individuals, that is, the degree of ventricular dysfunction There is no close correlation with the body's working ability. In other words, even if all patients have cardiac function level 3, the ADL assessment scores may be different. Some patients can achieve self-care, while others need to rely on

1. Measurement of activity ability

Although ADL assessment can be used as an indicator to determine the physical activity ability of patients with cardiovascular disease, patients with acute myocardial infarction cannot be allowed to perform these activities blindly. Activity, the patient's potential for physical activity must be measured realistically and objectively, and the actual energy consumed by a certain activity must be measured. In cardiac rehabilitation, this method is mainly achieved by measuring the metabolic equivalent levels of various activities. Energy consumption is generally used. Expressed in terms of metabolic equivalent (metabolic equivalent of the task, MET), the energy consumption when sitting quietly is 1 MET, which is equivalent to 3.5ml (O2)/(kg·min). When the patient gets up to walk or do other activities, this metabolic requirement and oxygen consumption Increase work-related factors in daily life, such as emotional use of small muscle groups. Activity and energy consumption in daily entertainment and self-care activities can have a non-linear relationship, which can continuously produce high heart rate conditions such as hot environments, emotional stress, and the use of upper limbs. ,

Isometric activities, especially in 2~3METs activities, rhythmic position, muscle group isometric technique and environmental factors can affect the energy consumption during activities. The metabolic equivalents of various activities can be obtained from Table 13-3-2 and Table 13 -3-3 Obtaining the electrocardiographic exercise test can measure the maximum metabolic equivalent of the patient's activity, which can be used as a basis for formulating an occupational therapy plan. Subjective fatigue level classification can also be used (see "Clinical Rehabilitation Function Assessment" for specific assessment methods)

Table 13-3-2 Energy requirements for various tasks (American Heart Association, 1989)

Table 13-3-3 Metabolic equivalents required for daily activities and recreation

2. Assessment of the disability level of patients with cardiovascular disease

As members of society, whether patients with cardiovascular disease can resume their normal social activities and play their role well in family society is a key factor The main indicators for evaluating cardiovascular rehabilitation results need to be understood during the evaluation process, including whether the patient can resume a normal sexual life as a couple at home, resume normal activities and interactions with family and friends, whether the patient can participate in recreational activities and resume paid work, and whether the patient can resume a paid job. Returning to a social role that the patient is satisfied with, whether he or she has a positive and optimistic attitude toward life, and a series of activity abilities will be used as indicators to judge the patient's physical work capacity and whether he or she can adapt to the needs of the social environment in which he or she lives, and guide therapists to choose appropriate occupational therapy. An important basis for helping patients truly become valuable contributors not only to their own families but also to society

The assessment of disability level is currently based on the patient's quality of life (QOL) and life satisfaction (lifesatisfaction) Health status (well-being), etc. Table 13-3-4 lists the main scopes related to quality of life established by the World Health Organization (WHO) after 1995. However, the questions in each scope listed in WHOQOL-100 are An overall comprehensive QOL, for each specific health problem, such as cardiovascular disease, cerebrovascular disease, cancer, etc., a unique QOL scale should be developed. Currently, there is no comparison at home and abroad in this regard. It is a recognized unified scale, but the six comprehensive ranges listed in WHOQOL-100 and the questions involved in each range are mostly applicable to patients with cardiovascular disease (for specific evaluation, please refer to the relevant assessment chapters )

Table 13-3-4 Main ranges in the WHOQOL-100 scale

3. Relationship between heart function classification and ability to return to work

Cardiovascular diseases The type and degree of impairment are very important in formulating rehabilitation procedures, but the correlation between cardiac functional classification and clinical conditions and maximum oxygen consumption and body work capacity are not very close, because oxygen consumption is a relatively easy Actual measured indicators, therefore, MET is usually used as the objective standard for energy requirements during specific work. Patients with clinical symptoms of cardiac function class III may still have metabolic equivalents reaching 4 METs, which means that patients can still engage in certain sitting positions, and even Mild or moderate work in a standing position. Therefore, it is necessary to have a good understanding of the relationship between the clinical situation of cardiac function classification and maximum oxygen consumption (Table 13-3-5)

4. Restore employment ability Assessment

Restoring employment ability is a very important thing for most patients with cardiovascular disease. The ultimate goal of cardiac rehabilitation is to improve the quality of life of patients with heart disease and allow patients to return to their families. Society, the assessment of the ability to return to work when returning to work not only depends on the exact diagnosis of the disease and the type of work expected to be resumed, but also is related to some other objective and subjective factors, which requires the body energy capacity and working environment of different types of work to be evaluated. Evaluation

Table 13-3-5 Relationship between clinical conditions of cardiac function classification and maximum oxygen consumption

(1) Energy requirements of different types of work: Table 13-3-6 Lists the physical energy requirements for some common types of work

Table 13-3-6 Physical energy requirements for common types of work

(2) Evaluation of the working environment: In the evaluation When determining the energy consumption and exertion required for a certain job, the impact of the working environment must be further considered, such as working under high temperatures and high temperatures.

Under humid high altitude (low pressure) conditions, although the energy requirements of a certain kind of work are not high, the work ability that the patient can bear is greatly reduced. Therefore, the rehabilitation program should be in a situation similar to the actual environment where the patient is about to return to work. For example, rehabilitation procedures implemented in air-conditioned rehabilitation institutions are not suitable for patients who will work outdoors in the future

(3) Determination of working capacity: The assessment of the patient's ability to resume work and social life must be Based on the following factors: diagnostic classification, different types of heart disease have different work abilities; the attitude and understanding of patients and their families towards recovery work; the nature of the recovery work and the patient's familiarity with the work, and whether the patient can be effective Can you adapt to the job well; can you get along well with and cooperate with your superiors?

(4) Work simulation and test: Work simulation and test are the last means to test the physical ability when returning to work. The patient's physical strength to return to work can simulate the special environment of the job. Physical strength tests are carried out in the workplace prepared for recovery. Usually, after physical training in the rehabilitation program in the hospital, they go to a rehabilitation center with a simulated working environment or a nearby factory or countryside. To implement If cardiac rehabilitation is performed in the community where the patient lives, the equipment needed for the work should be tried as close as possible or directly. Rehabilitation personnel should determine the patient's physical ability to return to the specific work based on the results of the simulated work. Administrative management is required. Personnel, such as manager team leaders and their colleagues, must understand the significance and safety of this work simulation and experiment, and patients and their families, rehabilitation personnel and community workers must also understand the same content