Eligibility, referral and assessment

1. Eligibility Criteria

People with tuberculosis need to be identified, assessed and referred to the pulmonary rehabilitation programme. The Medical officer at the PHC/Health and Wellness Centre or the chest clinics shall identify people affected with tuberculosis and on basis of the following to refer the candidate to the pulmonary rehabilitation programme.

Inclusion criteria

• Patients who have dyspnoea or cough due to Tuberculosis
• Patients with post TB fibrosis, pleural thickening, bronchiectasis, with fibro-cavitary lesions or with destroyed lungs diagnosed on basis of Radiology (X-Ray/ CT scan)
• Reduced exercise tolerance
• People with post tubercular obstructive airway disease diagnosed clinically or on spirometry
• People on treatment needing support with issues like psychosocial support/ de-addiction/ alcoholism/ smoking cessation 

Exclusion criteria

• People who are unable to walk or having locomotor issues
• People who have unstable angina or have had recent myocardial infarction or having unstable heart diseases like 
• People having difficulties following instructions due to cognitive or psychiatric impairments
• People with uncontrolled Blood Pressures, Diabetes, liver diseases, low haemoglobin levels or low oxygen saturations (<80%).

Pulmonary rehabilitation programme will benefit individuals who have completed treatment for tuberculosis or are on treatment as per the above mentioned inclusion/exclusion criteria. These include:

 

• Out-patients 
•  Immobile or in-bed patients, where the pulmonary rehabilitation programme can be offered near the bedside
• In-patients who can attend the pulmonary rehabilitation programme at the centre and come back post discharge to complete 3 months of the program

2. Referral for Pulmonary Rehabilitation 

The doctors at DR-TB center/ chest clinics/ peripheral health institutes should carefully evaluate every case of pulmonary TB completing treatment for the possibility of developing Post TB Lung Disease and then refer them to the pulmonary rehabilitation programme centre. The assessment should be conducted at the earliest and at the end of treatment. Basic examinations should be conducted with the aim to identify patients with sequelae at risk of deterioration and those likely to benefit from Pulmonary rehabilitation program. 

The following set of basic examinations is considered essential before referral to a pulmonary rehabilitation program: 

• Clinical examination and brief medical history
• Persistent symptoms
• Dyspnoea/breathlessness
• Disability of daily activities
• Sputum examination: smear / culture 
• Chest X-Ray
• Spirometry
• Six-minute walk test (6MWT)

3. Patient assessment at Pulmonary Rehabilitation Centre 

The patients will be enrolled on Pulmonary Rehabilitation Programs based on the clinician's referrals and indications for rehabilitation. Following this, they will be undergoing education and counselling regarding the importance of pulmonary rehabilitation and how it will affect their quality of life.

The patient card will be completely filled up with all the below mentioned. (patient card is depicted in Annex 4)

• Detailed and complete medical history of the person to be recorded
• Complete baseline clinical examination to be conducted 
• Assessment of quality of life using St. George questionnaire (Annex 1)
• Assessment of dyspnoea using modified MRC scale (Annex 2)
• Height, weight, Body Mass Index
• Hb% (Haemoglobin levels)
• Blood sugar levels- Fasting & Post prandial
• Pulmonary Function Test results
• X-Ray chest PA view
• Sputum for AFB
• ECG
• 6-minute walking test result with SpO2 levels (Annex 3)