Physiotherapeutic competencies in the process of rehabilitation of cardiovascular patients

U procesu kardiološke rehabilitacije, fizikalna terapija primjenjuje se za postizanje što boljeg fizičkog, psihičkog i socijalnog stanja bolesnika te njegova povratka aktivnostima svakodnevnoga života u obitelji i zajednici. U tom procesu, koji provodi interdisciplinarni tim, fizioterapeuti i njihove kompetencije imaju bitnu ulogu. Proces fizikalne terapije i rehabilitacije obuhvaća procjenu, intervenciju i evaluaciju u svim fazama, od koronarne jedinice pa do završne faze rehabilitacije. Fizioterapeutska procjena bolesnika sastoji se od subjektivnog i objektivnog pregleda, analize medicinske dokumentacije, fizioterapeutske anamneze, plana intervencija, postupaka mjerenja i testova. U procesu kardiološke rehabilitacije, posebne kompetencije fizioterapeuta potrebne su u dijagnostičkim pretragama (ergometrijsko testiranje, spirometrija, kontinuirano snimanje 24-satnog elektrokardiograma, kontinuirano snimanje 24-satnog krvnog tlaka, EKG, TCD i ehokardiografija), kojima se evaluiraju rezultati intervencija i opseg koronarnih bolesti. Kardiološka rehabilitacija dijeli se u tri međusobno povezane faze. Prva faza obuhvaća akutno i rano postakutno liječenje nakon akutnog koronarnog sindroma ili kardiokirurške operacije u koronarnim jedinicama i kardiološkim odjelima. Druga faza obuhvaća kasno postakutno liječenje, a obavlja se stacionarno, u specijaliziranim ustanovama za rehabilitaciju. Treća je faza doživotna, a obuhvaća trajno praćenje i skrb za bolesnike, što se provodi periodički, ambulantno te u bolničkoj ili izvanbolničkoj službi. Bitnu ulogu ima i prevencija kardiovaskularnih bolesti, kroz kontrolu čimbenika rizika, tjelesnu aktivnost, odnosno provođenje strategija djelovanja na razini pojedinca i cijele populacije. U radu su detaljno opisane fizioterapeutske kompetencije u procesu rehabilitacije kardioloških bolesnika.During cardiac rehabilitation, the aim of physical therapy is to achieve the best possible physical, psychological and social state of the patient and his return to daily activities within his family and the community. The rehabilitation of cardiac patients is a process conducted by an interdisciplinary team. In this team, physical therapists, with their competences, play an important role. Physical rehabilitation encompasses assessment, intervention and evaluation, from its beginning at the coronary unit to the end phase of rehabilitation. Physiotherapeutic assessment of the patient consists of subjective and objective examination, the analysis of medical documentation, patient physical therapy history, intervention plan, measurement procedures and tests. In cardiac rehabilitation, physiotherapy competences are important in diagnostic procedures (ergometry, spirometry, continuous 24-hour EKG, continuous 24-hour blood pressure monitoring, TCD and echocardiography) and are used to evaluate the results of interventions as well as the extent of coronary disease. Cardiac rehabilitation consists of 3 phases: 1) the phase of acute and early post-acute treatment, after the acute coronary syndrome or cardiac surgery (i.e., in coronary units and cardiology wards); 2) the phase of later (postacute) treatment, in specialized rehabilitation institutions; 3) the phase of continuing (lifetime) follow-up and patient care, with periodic visits to health care institutions. The prevention of cardiovascular diseases is very important and is implemented through the control of risk factors and regular physical activity, at the level of individual patients and the entire population. In this paper, we describe physiotherapeutic competences required for the successful rehabilitation of cardiac patients