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Rehabilitation Management of a Patient with Bilateral Pulmonary Bullae after Multiple Surgeries and Post-Tuberculosis Lung Disease Tifany, Elisabeth Pauline; Tambunan, Tresia Fransiska Ulianna
MAGNA MEDIKA Berkala Ilmiah Kedokteran dan Kesehatan Vol 12, No 1 (2025): FEBRUARY
Publisher : Universitas Muhammadiyah Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26714/magnamed.12.1.2025.94-103

Background: Post-tuberculosis lung disease (PTLD) is a prevalent finding in TB survivors. PTLD has many clinical presentations, including structural damage in the form of pulmonary bullae. Pulmonary bullae, along with PTLD, lead to significant impairment and morbidity in the patient. In some cases, a surgical approach is indicated for pulmonary bullae.Objective: This case study aims to discuss the rehabilitation management in PTLD, including post-surgical cases.Case Presentation: A 27-year-old male underwent lung volume reduction surgery (LVRS) by wedge resection of the right superior lobe. The patient had a history of tuberculosis infection and a history of bilateral pneumothorax. The patient underwent pulmonary rehabilitation in ICU care as early as medically possible, and continued until the patient was transferred to the general ward. The patient tolerates the pulmonary rehabilitation program, and no adverse effects occurred due to pulmonary rehabilitation.Conclusion: Pulmonary rehabilitation is an essential part of cases involving PTLD, including post-surgical ones, and should be initiated as early as medically possible in inpatient and continued outpatient settings.

Telerehabilitasi pada Penyakit Paru Obstruktif Kronik Tifany, Elisabeth Pauline; Tambunan, Tresia Fransiska Ulianna
Cermin Dunia Kedokteran Vol 50 No 12 (2023): Penyakit Dalam
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v50i12.1042

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Pulmonary rehabilitation is an essential component of COPD management and can be delivered through telerehabilitation programs. COPD telerehabilitation consists of exercise testing and training that can be performed at home with supervision from a physiotherapist or remotely using a smartphone application. Exercise training includes cardiorespiratory endurance, resistance, flexibility, and respiratory muscle training. COPD telerehabilitation is effective in improving exercise tolerance, reducing the incidence of acute exacerbations, and improving patients’ quality of life.

Return to Work in Post-Revascularization Patients with Acute Coronary Syndrome Undergoing Phase II Cardiac Rehabilitation Tambunan, Tresia Fransiska Ulianna; Wulandari, Najwa; Kurnain, Dave Nicander; Sianipar, Helisa Rachel Patricie
eJournal Kedokteran Indonesia Vol. 13 No. 3 (2025): Vol. 13 No. 3 - Desember 2025
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.13.1129.1

Returning to work is an essential indicator of functional and psychosocial recovery in post-revascularization patients with acute coronary syndrome (ACS). Participation in Phase II cardiac rehabilitation (CR) is believed to facilitate this process through structured exercise, education, and psychological support. This study aimed to evaluate the effect of Phase II CR on return-to-work outcomes among post-revascularization ACS patients. An evidence-based case report was conducted through a systematic search of PubMed, Scopus, ProQuest, ScienceDirect, and SpringerLink databases from 2013 to 2023. Eligible studies included randomized controlled trials, cohort studies, and systematic reviews that assessed return-to-work outcomes in patients undergoing coronary artery bypass grafting or percutaneous coronary intervention who participated in Phase II CR. Articles not available in full text, published before 2013, or unrelated to return-to-work outcomes were excluded. Three studies met the inclusion criteria: two systematic reviews and one prospective cohort study encompassing approximately 68,000 patients. All reported that CR participation improved physical function, quality of life, and the likelihood of returning to work. The average time to return ranged from 9 to 32 weeks, with higher rates among younger males with white-collar occupations and preserved ejection fraction. Phase II CR significantly enhances recovery and expedites return to work, underscoring its essential role in post-ACS care.

Penerapan Perhitungan Langkah Harian Pada Pasien Penyakit Paru Obstruktif Kroni Tresia Fransiska Ulianna Tambunan; Eugene Nathania; Elisabeth Pauline Tifany
Majalah Kedokteran Indonesia Vol 73 No 5 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.5-2023-1054

Chronic Obstructive Pulmonary Disease (COPD) is a condition which airflow limitation occurs due to an abnormality of the airways. The cause of COPD is usually exposure to noxious particles or gases. COPD is often accompanied by metabolic syndrome and leads to impaired physical activity, leading to increased morbidity and mortality. According to the international recommendation, COPD patients should receive a 30-minute daily step program. Pulmonary rehabilitation program with daily step count could be prescribed to all COPD patients who have no exacerbations within 4 weeks and able to ambulate. The pedometer can be used for ≥ 8 hours/day, ≥ 3 days/week, and a minimum of ≥ 100 steps/day. Increasing activity that can be assessed by calculating daily steps in patients with COPD can reduce the number of exacerbations, reduces the risk of death, increases exercise capacity, and improves the quality of life.

Correlation Between Six-Minute Walk Test and Treadmill Exercise in Post-Coronary Artery Bypass Phase II Rehabilitation Patients: A Cross-Sectional Study Tresia Fransiska Ulianna Tambunan; Audrey Witari; Helisa Rachel Patricie Sianipar
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1969

Background: Coronary Artery Bypass Grafting (CABG) improves survival in advanced Coronary Artery Disease (CAD) but is often associated with reduced functional capacity during recovery. Phase II cardiac rehabilitation improves physical performance, yet accessible and reliable tools are needed to monitor progress. Treadmill Cardiopulmonary Exercise Testing (CPET) is the gold standard for assessing aerobic capacity, but it is resource-intensive and not widely available in many settings. The Six-Minute Walk Test (6MWT) is a simple alternative, but its validity compared with treadmill testing in Indonesian post-CABG patientsremains underexplored Methods: This cross-sectional study was conducted at the National General Hospital Dr. Cipto Mangunkusumo in Jakarta between May 2023 and October 2024. Post-CABG patients who completed an eight-week Phase II cardiac rehabilitation program, were clinically stable, and able to perform both assessments were included. Functional capacity was determined by estimated VO2Max from the 6MWT and directly measured VO2Max from a symptom-limited treadmill test using the Modified Bruce protocol. Descriptive statistics summarized baseline characteristics. Spearman correlation coefficient was used to evaluate the relationshipbetween the two tests, with statistical significance set at p<0.05. Results: Fifteen post-CABG patients completed the study. Most were male (73.3%) with a mean age of 59 years. Overweight status was common (46.7%), with hypertension (80.0%), dyslipidemia (66.7%), and diabetes mellitus (53.3%) as frequent comorbidities. Mean 6MWTdistance increased from 307.8 ± 85.7 m pre-rehabilitation to 498.5 ± 140.7 m post-rehabilitation. The estimated VO2Max from the 6MWT followed a normal distribution and is reported as a mean of 18.9 mL/kg/min (SD = 4.2). In contrast, the treadmill-measured VO2Max was nonnormally distributed and is therefore reported as a median of 21.4 mL/kg/min. A significant moderate positive correlation was found between 6MWT and treadmill VO2Max (r = 0.689, p = 0.005). Conclusion: The 6MWT demonstrated a strong, significant correlation with treadmill-based VO2Max, supporting its use as a practical and cost-effective alternative for functional capacity assessment in post-CABG Phase II rehabilitation. Routine integration of the 6MWT may facilitate individualized exercise prescription and enhance patient monitoring, particularly in resource-limited settings.

Correlation Between Six-Minute Walk Test and Treadmill Exercise in Post-Coronary Artery Bypass Phase II Rehabilitation Patients: A Cross-Sectional Study Tresia Fransiska Ulianna Tambunan; Audrey Witari; Helisa Rachel Patricie Sianipar
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1969

Background: Coronary Artery Bypass Grafting (CABG) improves survival in advanced Coronary Artery Disease (CAD) but is often associated with reduced functional capacity during recovery. Phase II cardiac rehabilitation improves physical performance, yet accessible and reliable tools are needed to monitor progress. Treadmill Cardiopulmonary Exercise Testing (CPET) is the gold standard for assessing aerobic capacity, but it is resource-intensive and not widely available in many settings. The Six-Minute Walk Test (6MWT) is a simple alternative, but its validity compared with treadmill testing in Indonesian post-CABG patientsremains underexplored Methods: This cross-sectional study was conducted at the National General Hospital Dr. Cipto Mangunkusumo in Jakarta between May 2023 and October 2024. Post-CABG patients who completed an eight-week Phase II cardiac rehabilitation program, were clinically stable, and able to perform both assessments were included. Functional capacity was determined by estimated VO2Max from the 6MWT and directly measured VO2Max from a symptom-limited treadmill test using the Modified Bruce protocol. Descriptive statistics summarized baseline characteristics. Spearman correlation coefficient was used to evaluate the relationshipbetween the two tests, with statistical significance set at p<0.05. Results: Fifteen post-CABG patients completed the study. Most were male (73.3%) with a mean age of 59 years. Overweight status was common (46.7%), with hypertension (80.0%), dyslipidemia (66.7%), and diabetes mellitus (53.3%) as frequent comorbidities. Mean 6MWTdistance increased from 307.8 ± 85.7 m pre-rehabilitation to 498.5 ± 140.7 m post-rehabilitation. The estimated VO2Max from the 6MWT followed a normal distribution and is reported as a mean of 18.9 mL/kg/min (SD = 4.2). In contrast, the treadmill-measured VO2Max was nonnormally distributed and is therefore reported as a median of 21.4 mL/kg/min. A significant moderate positive correlation was found between 6MWT and treadmill VO2Max (r = 0.689, p = 0.005). Conclusion: The 6MWT demonstrated a strong, significant correlation with treadmill-based VO2Max, supporting its use as a practical and cost-effective alternative for functional capacity assessment in post-CABG Phase II rehabilitation. Routine integration of the 6MWT may facilitate individualized exercise prescription and enhance patient monitoring, particularly in resource-limited settings.

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