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Cardiovascular/Pulmonary Essentials: Applying the Preferred Physical Therapist Practice Patterns

Moffat M, Frownfelter D, eds. Thorofare, NJ 08086, Slack Inc, 2007, paperback, 299 pp, illus, ISBN: 978-1-5564-2668-1, $58.95.

The book distinguishes itself as a completely Guide-based resource that is based on disablement theory and uses the Guide's patient/client management model. It is well-referenced throughout and typically cites normative values for tests and measures and provides evidence for efficacy and effectiveness of interventions where available. References are generally current, and most cite peer-reviewed journals. Content is comprehensive, considering that it is not feasible for any reference to include every possible condition seen in the clinic.

Sensibly enough, the book is divided into 8 chapters, each of which corresponds to a cardiovascular/pulmonary practice pattern. Chapters are organized consistently and include, as appropriate for each pattern, sections on anatomy, physiology, pathology, and pathophysiology, as well as commonly used diagnostic or imaging procedures and pharmacological interventions. Each chapter also includes several case vignettes that represent common clinical scenarios. Each vignette is organized according to the patient/client management model, arranged by examination, evaluation, diagnosis, prognosis and plan of care, interventions, and reexamination. In addition, a discharge disposition is included for each case.

For each case, the physical therapist examination includes findings from a history, systems review, and relevant tests and measures. A subsequent evaluation based on the findings is followed by a discussion of physical therapist diagnosis, which highlights the pathology, impairments, functional limitations, and disability that place the patient in each practice pattern. Alternative practice patterns are suggested according to the features of the case. These sections can be particularly helpful to those unfamiliar with terminology used in the Guide as it reflects the clinical reasoning involved in patient/client management. Prognosis as presented in each case tends to be somewhat nonspecific, imparting the litany of characteristics that are "improved" as a result of physical therapist management; however, the plan of care does include important elements, such as number and pattern of visits and anticipated duration of the episode.

Intervention sections begin with a helpful, evidence-based rationale for the specific interventions that are listed subsequently. Included in each intervention section are coordination/communication and patient/client instruction as well as the more "hands-on" types of interventions, such as therapeutic exercise, as appropriate to the case. The sections on anticipated goals and expected outcomes, which cover a wide range of domains within and beyond the disablement model, generally present important measurable or observable outcomes that indicate a successful treatment outcome. For nearly every case, a section on reexamination reminds the reader that "reexamination is performed throughout the episode of care." Additional recommendations are provided for some cases, a few of which provide valuable detail regarding how the process will evolve as the case resolves.

Illustrations are used primarily to support the discussions of anatomy and physiology as well as pathophysiology. Tables are used liberally in some chapters to summarize features of the practice pattern or results from tests and measures used for the case. The chapter on neonates includes clinical algorithms that may be very useful, particularly for those not familiar with this particular practice environment.

The book succeeds in making the Guide more accessible to clinicians. Theory presented in the Guide is given form within each case as elements of pathology, impairments, functional limitations, and disability are addressed. What constitutes a systems review is also made explicit, as is the evaluation—as distinct from examination—in each patient/client case. The discussions of anatomy, physiology, and pathology offer valuable background, especially for clinicians who are changing practice settings or who do not commonly encounter these conditions in their practice. Coverage of the clinical practice considerations for each pattern is comprehensive. For each pattern, practitioners are provided with many useful examination and treatment strategies, including nutritional considerations, all placed within the framework of the patient/client management model. The section on deconditioning in chapter 2, "Pattern B," should be a "must read" for all physical therapists, given the ubiquity of this condition in clinical practice.

Among the drawbacks of this book are a fair number of misprints and relatively minor factual errors. For example, a formula for body mass index (BMI) given in several places uses different numbers to adjust for English measurements (705 vs 703). And, in one chapter, manual muscle testing is erroneously listed as an intervention. In addition, some terminology may vary from accepted usage. For instance, quantification of cigarette smoking history is presented as "packs-a-year" rather than in pack-years, which is the conventional measure.

Prevention of "diseases of civilization" (eg, diabetes, cardiovascular disease) is discussed in terms of "lifestyle choices" and "personal responsibility," concepts that are familiar to physical therapists but that minimize the social, cultural, economic, and political determinants of health. For example, at one point the book states that individuals with tobacco dependency "may not be motivated" to stop smoking, yet we know that many individuals who smoke have tried, unsuccessfully, to quit. This reflects the addictive nature of nicotine as well as the powerful influences of advertising and peer pressure. Furthermore, person-first language is not used when referring to individuals who are overweight or obese: (eg, "Mrs. X is an obese patient..."). These kinds of usage establish a subtle, if unintended, victim-blaming tone in the context of prevention.

Overall, the book's strengths far outweigh its weaknesses, and it succeeds admirably in connecting the Guide to the clinic. As such, it is a valuable addition to the library of clinicians and clinical departments that seek to incorporate the Guide into their practices.

Gary Brooks

G Brooks, PT, PT, DrPH, CCS, is Associate Professor, SUNY Upstate Medical University, College of Health Professions, Syracuse, NY.

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This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brooks, G. Search for Related Content PubMed Articles by Brooks, G. Related Collections Cardiac Conditions Social Bookmarking                      What's this?