Cardiac evaluation during physical rehabilitation of the complex medical patient

Many rehabilitation patients have cardiovascular disease as a primary or secondary diagnosis. Such patients require careful evaluation before institution of vigorous therapeutic exercise and activity regimens. However, conventional exercise tests are often inappropriate due to orthopedic, neurologic, or functional limitations. This article introduces a new method of cardiac assessment, called the Trendscriber Evaluation (TE). The TE uses the Trendscriber, a cardiac telemetry unit which provides a hard-copy single-lead electrocardiogram (SECG) printout and digital heart rate monitor. The TE was developed to assess SECG, hemodynamic, and symptomatic responses during preestablished submaximal levels of activity. Specially trained physical and occupational therapists conduct the evaluation, directing the patient and monitoring vital signs. Results are interpreted by a staff cardiologist. For two years this technique was evaluated for 100 patients in the form of a medical records review. Eighty-nine percent of the patients' TEs identified cardiac abnormalities with heart rhythms, hemodynamic response, or both. Arrhythmia activity not detected on the routine 12-lead electrocardiogram (ECG) was recorded in 49.5% of the TEs performed. Fifty-seven percent of the records revealed activity-related ventricular ectopic activity. Data uncovered by the TE resulted in alteration of medical and/or rehabilitation therapy in 63% of the patients. The review suggests that the TE is a valuable tool in identifying problems related to cardiovascular performance and in providing the health care team with information important for patient management.