Pre‐transplant short physical performance battery: Response to pre‐habilitation and relationship to pre‐ and early post–lung‐transplant outcomes

Wickerson, Lisa; Rozenberg, Dmitry; Gottesman, Chaya; Helm, Denise; Mathur, Sunita; Singer, Lianne G.

doi:10.1111/ctr.14095

Cited by 25 publications

(33 citation statements)

References 32 publications

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“…Functional outcomes were lower compared to recent data of our center-based program where 6MWD was preserved during short-term prehabilitation and the SPPB improved pretransplant [20,21]. Improvements in pretransplant exercise volumes were lower with telerehabilitation than what has been seen historically in our center-based rehabilitation program (ie, increased treadmill speed and quadriceps weight used for resistance training) [4,19,20].…”

Section: Discussioncontrasting

confidence: 63%

“…As only a small number of LTx recipients underwent a 6MWT three months after transplant, it is not clear if LTx recipients reach the same functional benefit exercising at home versus a center-based program of supervised exercise three days per week from hospital discharge to three months posttransplant. Historically, LTx recipients achieve a 6MWD between 64%-76% predicted three months posttransplant [1,21].…”

Section: Discussionmentioning

confidence: 99%

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Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation

Wickerson¹,

Helm²,

Gottesman³

et al. 2021

JMIR Mhealth Uhealth

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Background The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). Conclusions We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation

Wickerson¹,

Helm²,

Gottesman³

et al. 2021

JMIR Mhealth Uhealth

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“…The relationship of performance-based measures of exercise capacity, physical function, and frailty with healthcare utilization in lung transplant candidates was studied in 8 studies. 10 , 14 , 45 , 51 , 53 , 60 , 63 , 64 Five studies examined the relationship of the 6MWT with hospital LOS 14 , 51 , 53 , 63 , 64 and 3 studies with ICU LOS. 51 , 63 , 65 Of those, 2 studies showed a significant relationship of a higher 6MWD with hospital LOS 51 , 64 and 1 with ICU LOS, 51 using similar cutoffs of 346 51 and 350 m 64 for the 6MWD.…”

Section: Resultsmentioning

confidence: 99%

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review

Bourgeois

Shallwani

Al-Huda

et al. 2022

Transplantation Direct

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Background. Measures of exercise capacity, frailty, and physical function are commonly used in lung transplant candidates and recipients to evaluate their physical limitations and the effects of exercise training and to select candidates for transplantation. It is unclear how these measures are related to clinical outcomes and healthcare utilization before and after lung transplantation. The purpose of this scoping review was to describe how measures of exercise capacity, physical function, and frailty are related to pre- and posttransplant outcomes. Methods. We considered studies of any design that included performance-based tests of exercise capacity, physical function, and frailty in adult lung transplant candidates or recipients. Outcomes of interest were clinical outcomes (eg, mortality, quality of life) and healthcare utilization. Results. Seventy-two articles met the inclusion criteria. The 6-min walk test (6MWT) was shown to be related to mortality on the waiting list with different distance values as cutoffs points. There were inconsistent results regarding the relationship of the 6MWT with other clinical outcomes. Few studies have examined the relationship between the cardiopulmonary exercise test or the short physical performance battery and clinical outcomes, although some studies have shown relationship with survival posttransplant and quality of life. Few studies examined the relationship between the tests of interest and healthcare utilization‚ and the results were inconsistent. Conclusions. Except for the relationship between the 6MWT and mortality on the waiting list, there is limited evidence regarding the relationship of performance-based measures of exercise capacity, frailty, and physical function with clinical outcomes or healthcare utilization.

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“…Frailty poses a possible three-fold increase in mortality in lung diseases [5 ▪ ,6–8]. Incident frailty is high across ILDs and influences time to mortality [5 ▪ ,9,10 ▪▪ ,11 ▪▪ ,12 ▪▪ ,13,14,15,16,17 ▪ ] and transplant success [9,10 ▪▪ ]. Overall functional status [5 ▪ ,9,10 ▪▪ ,11 ▪▪ ,12 ▪▪ ,13,14,15,16,17 ▪ ] and ILD subtype should factor into prognostication more than age [18 ▪▪ ].…”

Section: Frailty and Health Related Quality Of Lifementioning

confidence: 99%

“…Preventing deterioration toward frailty is an important goal of ILD care [10 ▪▪ –12 ▪▪ ,14–17 ▪ ]. Central to this is the recognition and management of non-ILD health events and conditions commonly occurring in the general population (Table 1).…”

Section: Processes Of Ageing and The Impact On Interstitial Lung Diseasementioning

confidence: 99%

Ageing with Interstitial lung disease: preserving health and well being

Saketkoo

Ndili

Patterson

et al. 2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewAgeing, the accrual of molecular and cellular damage over a lifetime confers progressive physiologic dysfunction of bodily systems, leaving the body in a heightened state of vulnerability to biophysical and psychosocial stressors. The inflection point is frailty which easily leads to disability and death. Interstitial lung disease (ILD) creates biophysical and psychosocial stresses difficult for even optimally fit patients to cope with. With evolving ILD treatment pathways, people with ILD are living longer. Recent findingsILD and ageing are bi-directionally influential: ILD, its treatments, complications, and collateral systemic extra-pulmonary damage (hypoxic and oxidative stress) wear on the ageing person and ageing impacts a person's tolerance of ILD. ILD extent may proportionally accelerate age-related vulnerabilities. ILD related to inflammatory systemic diseases, e.g. connective tissue diseases or sarcoidosis, exert an even more complex biophysical impact on the body.

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Pre‐transplant short physical performance battery: Response to pre‐habilitation and relationship to pre‐ and early post–lung‐transplant outcomes

Cited by 25 publications

References 32 publications

Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation

Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review

Ageing with Interstitial lung disease: preserving health and well being

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