Table 6.

Evaluation and screening instruments for each goal in physical therapy

Goal	Evaluation instrument	When	Final outcome
Specific physical goals
I. Optimising exercise capacity	By physician • Maximum or symptom-limited exercise test with gas analysis plus Borg RPE scale (6–20), and as desired scoring Anxiety, Angina and/or Dyspnoea	At start and end of CR and / or training program	Exercise capacity is at optimum or target level for this patient
	By cardiac rehabilitation coordinator • Subjective physical score on KVL-H questionnaire
	By physiotherapist • As for goals one and two • (modified) SWT • Possibly MET method and/or SAS	At start, every 4 weeks and at end of CR and/ or training program	Functional exercise capacity is at optimum or target level
II. Balancing exertion with physical abilities	• Compare subjective exercise capacity score with objective score • Ask about five most problematic activities (PSC) and score these on the Borg RPE scale (6–20); possibly score anxiety and/or angina and/or dyspnoea	At start and end of CR and / or training program, but also continuous evaluation to check for excessive strain	Patient (and partner) coping effectively with symptoms, that is, patient avoids excessive strain and (if possible) improves exercise capacity (goal one). Patient is able to spread his/her energy expenditure and to deal with the dyspnoea in a functional way
III. Reducing fatigue, dyspnoea and inactivity	• Borg RPE scale (6–20) for fatigue and dyspnoea • Monitor Movement and Health (www.tno.nl) (in Dutch)	At start and end of CR and / or training program	Patient’s sensation of fatigue and dyspnoea is at optimum or target level. Patient has adopted a physically active lifestyle
General physical goals
1. Exploring one’s own physical limits	• Ask for five most problematic activities (PSC) • Ask patient to carry out problematic activities and possibly score them for duration and quality, perceived fatigue (Borg RPE 6–20) and in terms of anxiety and / or Angina and / or Dyspnoea (if indicated). • Monitoring heart rate and blood pressure	At start and end of CR and / or training program	Patient is aware of his/her own physical limits, i.e. knows what level of exertion is possible
2. Learning to cope with physical limitations		Monitoring heart rate, measuring blood pressure and scoring on Borg scale before, during and after each session	Patient can cope with physical limitations and utilise his/her limited energy efficiently, and has achieved a balance between exertion and relaxation
3. Overcoming fear of physical exertion	• History-taking and observation • Questionnaire: see Multidisciplinary Guideline CR 2011 (www.nvvc.nl) (in Dutch)	At start and end of CR and / or training program	Patient is no longer afraid of exertion
4. Developing an active lifestyle	• History-taking (motivational interviewing) • Monitor Movement and Health (www.tno.nl) (in Dutch) • Post-CR activities started	At start and at end of CR and / or training program	Patient has adopted an active lifestyle or is able to keep up the most active achievable lifestyle
Focal points
Acquiring information about secondary prevention	• Checklist for risk factors / unhealthy behaviour • Phase III activities started • Ability to cope effectively with symptoms • Ability to recognise signs of decompensation	At start and at end of rehabilitation and / or training program	Patient knows about healthy living and secondary prevention
Goals of relaxation program	• Evaluation list • Using a flowchart	At interim and final evaluation of CR and / or relaxation program	Patient is familiar with the relaxation program and is able to relax

Borg RPE scale Borg Rating of Perceived Exertion, KVL-H Dutch quality of life questionnaire for heart patients, 6MWT 6-min walking test, MET metabolic equivalent of task, PSC Patient-specific complaints, SAS Specific activity scale, SWT Shuttle walk test, CR cardiac rehabilitation