Condensed Outpatient Rehabilitation Early After Lung Transplantation: A Retrospective Analysis of 6-Minute Walk Distance and Its Predictors

Abstract

The objectives were to evaluate the effect of a condensed post-lung transplant outpatient rehabilitation program started immediately after hospital discharge on 6-minute walk distance (6MWD) and to explore predictors of change in 6MWD and time to complete rehabilitation. Methods: Data were retrospectively collected from July 2009 to February 2019 on recipients who completed physical therapy-based posttransplant outpatient rehabilitation (PTOR). Changes in 6MWD prerehabilitation to postrehabilitation were assessed using repeated measures, and predictors were assessed using multiple linear regression. Results: Participants (N 5 819, 61% men, 61 years) began PTOR 2 days (interquartile range [IQR] 1-3) after hospital discharge. The mean 6MWD of 324 m (SD 5 107) improved after rehabilitation to 488 m (SD 5 105). Factors associated with improvement were younger age (P 5 .003), higher baseline forced expiratory volume in 1 second (FEV 1 ) (P , .001), and lower baseline 6MWD (P , .001). Participants averaged 22 sessions in 41 days (IQR 35-50); with lower baseline FEV 1 (P 5 .002) and 6MWD (P , .001) associated with longer completion time. Conclusions: A condensed outpatient rehabilitation program early after lung transplantation was associated with a large, clinically meaningful improvement in 6MWD. Salient predictors of improvement included age, lung function, and starting 6MWD. These findings from a large cohort of lung transplant recipients who participated in PTOR can assist clinicians in tailoring strategies to optimize patient management.

Functional Recovery After Lung Transplantation Using a Comprehensive Rehabilitation Model

“…The current study reports significant gains in endurance (6MWD) of up to 91%, the closest to healthy performance that has been described in a 5-day per week postoperative outpatient rehabilitation program. 16 Although previous reports of endurance recovery range from 65% to 85% by 3 months after transplant, 3,12,13,25 data from the same center before the COLTT program reported recovery of 6MWD from 82% to 85% at 6 and 12 months after transplant. 25 Walsh et al 12 reported a 3% to 66% recovery in 6MWD in the first 6 weeks after transplant and suggested the inconsistent gains are due to the variation among rehabilitation programs.…”

“…This represents a more timely functional recovery than previously reported. 13,16,25 It is unclear which components of the program resulted in the accelerated recovery experienced by the participants; however, the finding that strength changes (1-minute sit to stand) are correlated with endurance changes (6MWD) suggests the addition of strength training may be a factor. Other studies have shown this correlation in healthy adults, patients with COPD, lung transplant candidates, and lung transplant recipients.…”

“…3,4,12,13 More evidence is emerging that 3 to 5 weeks of rehabilitation 5 days per week after lung transplant results in significant endurance gains. [14][15][16] Primarily these studies have been performed in the inpatient setting. A recent systematic review of exercise training in lung transplant recipients describes most outpatient programs as having a frequency of 3 times per week 17 with only Byrd et al 16 highlighting the effectiveness of a 5-day per week outpatient program.…”

“…Endurance-based rehabilitation (2-3 times per week) has been the common posttransplant model with few including individualized strength and balance training. 2,13,16,18 Quadriceps muscle loss has been reported perioperatively at 15% to 32%, and strength training has been recommended as part of a postlung transplant exercise program. 2 Although resistance training and multimodal exercise have been reported in 8 recent randomly controlled trials, no consensus on the approach, outcome measures, or timing of intervention has been identified.…”

“…14-16 Primarily these studies have been performed in the inpatient setting. A recent systematic review of exercise training in lung transplant recipients describes most outpatient programs as having a frequency of 3 times per week 17 with only Byrd et al 16 highlighting the effectiveness of a 5-day per week outpatient program.…”