Treatment of Systemic Lupus Erythematosus (SLE) Exacerbation
ICF
Environmental Factors
Restrictions in Participation
Limitations in Activity
Impairments in Body Structure
Personal Factors
Lives in a two-story home
Teaches kindergarten full time
Married to building contractor
Currently unable to work full time (Would clarify within Evaluation)
Inability to participate in social events (Would clarify in Evaluation)
Decreased ability to perform ADLs (Would clarify in Evaluation)
Mildly anemic
Chest discomfort
Joint achiness
Shortness of breathe
Painful joints
Pericarditis
Fever and chills
38-year-old woman
Kindergarten teacher
Married to building contractor
18 lb weight loss (possible continuous trend)
Lives in a two story home
Has three children
Inability to play with her 3 children (Would clarify in Evaluation)
Difficulty negotiating stairs within home (Would clarify in Evaluation)
Diagnosed with Systemic Lupus Erthematosus 3 years ago
Reduced exercise intolerance
Exacerbation over the last 3 weeks
Medical Management
Physical Therapy Evaluation
Physical Therapy Intervention (All exercise, we will monitor BP, HR, RR, and use the RPE to monitor perceived exertion of the patient to maintain safety)
Corticosteroids
Patient Education on medications, any potential side effect, and possible reoccurrence of SLE
Lab Values: specifically blood cell count
Breathing Assessment
Reflexes
Circulatory Tests
Test for Alertness and Orientation
Vitals
Functional Mobility
Heart and Lung Auscultation
Sensation
MMT
ROM testing
EKG observation for potential ST segment changes
Chest and lung imaging
Skin test
Patient history
Any specific daily limitations?
Eating habits/poor appetite?
Current exercise routine?
Restrictions in current employment?
Any headaches/seizures?
Any behavioral changes?
Resistance training to help strength of immune system, and also help improve overall strength of global muscles to further decrease the amount of work needed by the heart. Exercise will be performed at 40-85% of the patient's 1 rep max. The 1 rep max was used in multiple studies to be safe in those with this diagnosis and could be performed when applicable to this patient (Abrahão, et al, 2016).
ROM
Mindfulness-based therapy to improve full body awareness during daily activities, stress management, and to decrease possible behavioral avoidance of those with SLE (Horish, et al, 2017).
Patient Education
Vitals
Sleep habits
Nutrition
Ambulation
Referral to RD due to pattern of progressive weight loss, and for potential vitamin and mineral supplementation in result of possible poor appetite and/or other contributing factors
Importance of monitoring current HR and fatigue during exercise
Cardiovascular training to help strength of immune system, but more importantly improve aerobic capacity to improve efficiency of oxygen transport and to improve efficiency of the heart and to decrease the amount of work on the heart. Cardiovascular exercise will be performed at a moderate intensity, 3 days a week, as this implementation has shown its' benefits on those with an exacerbation of SLE (Abrahão, et al, 2016).
Outcome measures
SF-36
Ambulation to improve full body functional exercise capacity (Pinto, et al, 2016).
References
Abrahão, M. I., Gomiero, A. B., Peccin, M. S., Grande, A. J., & Trevisani, V. F. M. (2016). Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scandinavian journal of rheumatology, 45(3), 197-201.
Arm and bicycle ergometer to improve UE and LE aerobic capacity (Pinto, et al, 2016).
Close monitoring of vitals including HR, blood pressure, RPE during all cardiovascular exercise
Weight training/Resistance band training
Functional strength training to enable client to be efficient with energy when performing functional activities at home
Improve QOL and VO2 max (Pinto, et al, 2016).
Pinto, A. J., Miyake, C. N., Benatti, F. B., Silva, C. A., Sallum, A. M., Borba, E., ... & Gualano, B. (2016). Reduced aerobic capacity and quality of life in physically inactive patients with systemic lupus erythematosus with mild or inactive disease. Arthritis care & research, 68(12), 1780-1786.
Fatigue Severity Scale (FSS)
Pain Scale
Energy management strategies
Importance of sleep on weight management and exercise benefits
Horesh, D., Glick, I., Taub, R., Agmon-Levin, N., & Shoenfeld, Y. (2017). Mindfulness-based group therapy for systemic lupus erythematosus: A first exploration of a promising mind-body intervention. Complementary therapies in clinical practice, 26, 73-75.
Diaphragmatic breathing to ensure proper breathing pattern throughout daily lifestyle and exercise, and to improve shortness of breathe
A global strength training program will be implemented while vital signs and RPE will be closely monitored. This program will progress as patient's condition becomes more stable. The program will be progressed to 3 sets of 10-12 repetitions at 40-85% of 1 RM with rest breaks in between each set as per up to date EBP.
Stress reduction program to help improve psychological function, pain, and physical function (Greco, et al, 2004).
Greco, C. M., Rudy, T. E., & Manzi, S. (2004). Effects of a stress‐reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: A randomized controlled trial. Arthritis Care & Research, 51(4), 625-634.
Improve QOL (Pinto, et al, 2016).
Pursed lip breathing to help improve shortness of breathe
Range of motion activities will be performed immediately to increase synovial fluid within the joints and help alleviate joint pain
Discharge Planning
Discharge to Home PT. Outpatient PT will be recommended once exacerbation fully stabilizes.
Patient positioning to help alleviate systems of pleural effusion and if any lines and tubes are being used at the time
Stair training
Help client's efficiency when negotiating her 2 story home
Systemic Lupus Activity Measure (SLAM)
Past Medical History