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Research Objectives
To describe the multidisciplinary rehabilitation management of two patients status
post LVAD implantation when complicated by right sided heart failure and RVAD placement.
Design
The design of the study was a case study.
Setting
The setting of this case study was a 746-bed tertiary hospital in Allentown, PA. Both
patients were admitted to heart failure service and treated by cardiopulmonary service
line which consists of physical therapy, occupation therapy, and phase one cardiac
rehabilitation.
Participants
Two patients were included in this case study. Patients were selected based on the
criteria of requiring RVAD support following new LVAD implantation.
Interventions
Treatment program consisted of bed mobility, transfer training, balance training,
muscle strengthening, LVAD management tasks, assisted cough/deep breathing techniques,
energy conservation education, activities of daily living management, and progressive
ambulation.
Main Outcome Measures
Outcome measures performed included the Boston University AM-PAC "6-clicks" Inpatient
Basic Mobility and Daily Activity Short Forms, six minute walk test, Tinetti Gait
and Balance Assessment, grip strength measurement, Montreal Cognitive Assessment,
and Kansas City Cardiomyopathy Questionnaire.
Results
Case One received 18 PT sessions, 19 OT sessions, and 19 CR sessions post LVAD implantation
during acute care stay. Of these sessions, nine were completed in the presence of
RVAD. Patient's AM-PAC score improved from 7/24 to 17/24 on Basic Mobility Short Form
and 10/24 to 18/24 on Daily Activity Short Form. Patient was discharged to the acute
inpatient rehabilitation center on hospital day 56.
Case Two received 23 PT sessions, 19 OT sessions, and 8 CR sessions post LVAD implantation.
15 sessions were completed in the presence of RVAD. Improvement in AM-PAC score was
documented from 6/24 to 24/24 on both Basic Mobility and Daily Activity Short Form.
The progression in functional status allowed this patient to be discharged directly
home with home services on hospital day 45.
Conclusions
This case study demonstrates that rehab services can be safety implemented following
LVAD implant complicated by RVAD placement when the appropriate multidisciplinary
team approach is utilized.
Author(s) Disclosures
No financial disclosures or conflicts of interest.
Key Words
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© 2022 Published by Elsevier Inc.
