Advertisement
The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

mHealth to Improve Emergent Frailty after Lung Transplantation

      This paper is only available as a PDF. To read, Please Download here.

      Purpose

      Post-transplant frailty is a risk factor for poorer health-related quality of life, rehospitalization, and death. We aimed to evaluate the feasibility, safety, and efficacy of a remote mHealth-supported physical activity pilot intervention to treat frailty in lung transplant recipients following discharge from their index hospitalization.

      Methods

      We screened lung transplant recipients for frailty at the time of discharge at the University of Pennsylvania and UC San Francisco. Frailty was defined as a Short Physical Performance Battery (SPPB) score ≤7 and pre-frail as 8-9 (range 0-12, higher scores reflect less frailty). The primary intervention modality was Aidcube, a customizable app-based platform for home-based pulmonary rehabilitation providing personalized exercise prescriptions, for 8 weeks post-discharge. The primary aims included tolerability, feasibility, and acceptability of use of the mHealth platform. Additional outcome measures were changes in SPPB score and in scores of physical activity and disability measured using the DASI and LT-VLA.

      Results

      No adverse events were reported across the 18 study subjects throughout the 152 subject-week study time. Several themes emerged from weekly subject feedback. Subjects reported that the app was easy to use and that usability improved over time. Subjects also found that app use enhanced motivation to engage in post-transplant rehabilitation. Comments also highlighted the complexities of rehabilitation after lung transplant surgery, including level of functional decline, pain, tremor, and fatigue. At the end of the intervention, SPPB scores improved a median of 5 points (IQR 4, 7; p<0.0001) from a baseline of 4 (IQR 0, 7). Physical activity and patient-reported disability also improved. The DASI improved from 4.5 (IQR 0.0, 10.0) to 19.8 (IQR 15.2, 32.3)) (p=0.001) and LT-VLA score improved from 2 (IQR 1.2, 2.53) to 0.59 (IQR 0.14, 1.18) (p=0.001) at closeout.

      Conclusion

      Utilization of a personalized, app-based rehabilitation platform with participant-specific exercise prescriptions was safe and well received by post-lung transplant recipients. Remote rehabilitation was associated with improvements in frailty, physical activity and disability. Future studies should further evaluate mHealth treatment modalities in larger-scale randomized trials of lung transplant recipients.