Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

Abstract

Background Cardiopulmonary transplantation is becoming a more common treatment option for advanced heart and/or lung disease. Specialist rehabilitation programs may assist recovery and enhance functional independence following transplantation. Objective To quantify the outcomes of multidisciplinary inpatient rehabilitation following cardiopulmonary transplantation and describe cohort characteristics. Design Retrospective cohort study. Setting Subacute inpatient rehabilitation facility, located on‐site at Australia's largest cardiopulmonary transplant center. Participants Heart and/or lung transplant recipients (n = 116), admitted for multidisciplinary inpatient rehabilitation, between 2009 and 2016. Interventions All participants received multidisciplinary rehabilitation as part of their standard care. Main Outcome Measurements Participants' functional independence was scored using the Functional Independence Measure (FIM) upon rehabilitation admission and discharge. Physical measures of mobility and balance were assessed at the same time points, including the 6‐minute walk test, 10 m walk, Timed Up and Go, and Berg Balance Scale. Process measures of interest included rehabilitation length of stay, interruptions to rehabilitation, and discharge destination. Results Average length‐of‐stay in rehabilitation was 26.9 ± 21.2 days (mean ± SD). FIM scores improved from 79.8 ± 20.3 on admission to 101.8 ± 29.1 at discharge (P < .001) for the pooled cohort. Physical measures of mobility and balance also improved: 6‐minute walk test distances improved from 103.6 ± 80.1 to 183.2 ± 104.8 m (P < .001); Timed Up and Go results decreased from 26.4 ± 18.3 seconds to 16.5 ± 14.1 seconds (P < .001); and Berg Balance Scale scores increased from 26.8 ± 17.1 to 45.0 ± 9.4 (P < .001). Approximately one‐third (33.6%) of admissions were interrupted by an acute medical complication; however, this did not preclude completion of rehabilitation or achievement of functional gains. Ninety‐four percent of the cohort was discharged to a private residence following rehabilitation. No significant differences were observed between heart versus lung transplant recipients. Conclusions For debilitated patients following heart and/or lung transplantation, physical function, mobility, and independence significantly improved following multidisciplinary inpatient rehabilitation. Level of Evidence III

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

“…68 Preliminary data from retrospective cohort studies suggest that multidisciplinary inpatient rehabilitation might be a viable treatment option for debilitated patients following heart and/or lung transplantation. 81,82…”

Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review

“…Other risk factors identified across studies included: elevated white blood cell count, abnormal haemoglobin level on admission, indwelling devices, such as an indwelling urethral catheter or feeding tube, greater neurological deficit, or a history of pneumonia (p < 0.001), cardiac arrhythmia (p < 0.01) and dyspnoea requiring oxygen (17,27). Timing of transfers varied; Robinson et al (37) (39) noted that all recorded deaths (n = 5) were related to underlying disease states and were amongst patients who had required RTAC, and subsequently died in acute care (39). Carney et al (44) reported an increased proportion of deaths in patients who required RTAC within the first 3 days of admission for rehabilitation (11%) in comparison with those who were transferred later (5%).…”

Exercise after Heart Transplantation: Typical Alterations, Diagnostics and Interventions

“…Shortly after transplantation, endurance training should be started with MICT at low intensity ( < 50 % of the peak VO 2 or 10 % below the first ventilatory threshold) [32]. Exercise intensity should be determined using the Borg scale (RPE [11][12][13][14] and/or the respiratory rate ("speech rule"), which means that the respiratory rate should permit conversation [31,32]. Intensity of MICT can also be defined as up to 50 % of the maximum load (watt) achieved during CPET [31,32].…”

“…In general, all measures performed shortly after HTX should be gentle on the patient's sternum due to surgery. A gradual increase in upper-extremity extent of motion and resistance training should be considered up to 3 months after transplantation [11].…”

“…Participation in a cardiac rehabilitation programme after discharge from acute hospital care varies amongst the different countries and also depends on the patient's degree of debility [11]. The overall readmission rate after HTX is highest in the first year (40 % of patients) and decreases clearly in the long term (25 % are readmitted in the time between 2 and 5 years) [7].…”