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Introduction: Frailty at listing for lung transplant has been associated with waitlist and post-transplant mortality. Frailty trajectories following transplant, however, have been less well characterized, including whether recipient frailty improves. The objective of this study was to identify prevalence and risk factors for frailty at discharge and to evaluate changes in frail recipients enrolled in an outpatient physical therapy program. Methods:This was a single-center prospective cohort study of lung transplant recipients. Enrollees completed a short physical performance battery (SPPB) to assess frailty at listing and at initial hospital discharge. Results:Of the 111 enrolled recipients, none were frail at listing and 18 (16.2%) were prefrail. At discharge, however, 60 (54.1%) patients were frail. Discharge frailty was associated with prefrailty at listing, acute kidney injury post-transplant, and longer intensive care unit stay. Among the 35 patients who were frail at discharge and who were enrolled in an outpatient PT program, the median improvement in SPPB was 6 points (IQR = 5-7 points), and 85.7% became not frail over a median of 6 weeks.Conclusion: Discharge frailty is common following lung transplantation. In most frail patients, an intensive outpatient physical therapy program is associated with improvement in frailty, as assessed by the SPPB. K E Y W O R D Sfrailty, lung transplantation, physical therapy, rehabilitation, short performance physical battery 2 of 7 | COURTWRIGHT eT al.length of stay. 9-12 Among lung transplant candidates, listing frailty, as measured by the SPPB, has been associated with increased waitlist mortality and death following transplantation. 13,14 There are, however, limited data in lung transplant on frailty trajectories from listing to post-transplant hospitalization discharge, including what fraction of recipients leave the hospital frail. Because it is unclear whether and to what extent frailty is a reversible state once it develops, identifying nonfrail candidates who are at risk for leaving the hospital frail is essential for targeted "prehabilitation" and rehabilitation efforts to reverse or stabilize frailty trajectories.Similarly, although there is an emerging literature suggesting that frailty in patients with advanced lung disease may be reversible, there are few studies reporting on programs designed to improve frailty in transplant recipients. 15-17 Understanding the extent to which frail recipients can be rehabilitated is an important starting point in evaluating whether improving frailty ameliorates the associated adverse outcomes. The primary objective of this study was to identify prevalence and risk factors for frailty at transplant hospitalization discharge. The secondary objective was to report subsequent changes in frail recipients enrolled in an intensive outpatient physical therapy (PT) program. | ME THODS | Study design and patient populationThis was a prospective cohort study at the Hospital of the University of Pennsylvania (HUP) from March 1, 2016, ...

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OBJECTIVE To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with COVID-19. DESIGN Retrospective cohort study SETTING An academic health system in the United States consisting of five inpatient hospitals. PARTICIPANTS Adult patients (N=1486) urgently or emergently admitted, tested positive for COVID-19, and had at least 1 AM-PAC assessment. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES Discharge destination, hospital length of stay, in-hospital mortality, and readmission. RESULTS 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (OR = 0.867 and 0.833, respectively) and activity scores (OR = 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (AUC = 0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, while specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (OR = 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged LOS (OR = 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC = 0.659-0.679). AM-PAC scores did not predict re-hospitalization. CONCLUSION Functional status as measured by the AM-PAC “6-clicks” measures of mobility and activity are independent predictors of key clinical outcomes individual hospitalized with COVID-19.