The feasibility of a group stress management Liver SMART intervention for patients with end-stage liver disease: A pilot study

Abstract

Twenty-nine English-speaking United Network for Organ Sharing-registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.ResultAttendance rate was 69.40%. The intervention was rated as "good" to "excellent" by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.Significance of resultsThe liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.

European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates

“…Rationale: One study was identified that was specifically designed to assess the feasibility of delivering a psychosocial prehabilitation in solid organ transplant candidates. This study showed that a stress management and relaxation training program in liver transplant candidates was efficiently deliverable and considered acceptable and tolerable by the patients [67]. However, the enrolment rate was low, (29%) and the attrition rate was moderate (68%).…”

“…[19][20][21][22][23][24][25], 7 for nutritional interventions [26][27][28][29][30][31][32], and 6 for psychosocial interventions [33][34][35][36][37][38]. In addition, 25 non-randomized studies regarding exercise , and 4 non-randomized studies on psychosocial interventions [65][66][67][68] were retrieved by literature review (Supplementary File S1). The small sample size per study and the limited size and heterogeneity of the total populations studied, the variability in interventions and outcomes measures, the generally low-to-moderate quality of the methodology, and-as a result-the inconsistency of findings across studies (Tables 2-4), warrants high-quality studies on multimodal prehabilitation before solid organ transplantation.…”

“…Nutrition intervention studies mostly used nutritional support to optimize energy intake and/or obtain weight loss [29-32, 69, 70]. Whilst psychosocial interventions predominantly included cognitive behavioral therapy [33,34,36,37,65,67], psycho-educational interventions [35,68] and stress management and relaxation techniques [38,67] or a combination of these interventions. Studies are needed that will help determine the modalities of the intervention, and for each modality (exercise, nutrition or psychosocial), the intervention characteristics (frequency, intensity and timing), the delivery mode (type of interventionist, level of supervision, home-based versus in-or outpatient) for each type of donor organ recipient.…”

“…Rationale: Six studies utilized elements of cognitive behavioral therapy (CBT) and psychoeducational interventions [33,34,36,37,65,67] of which five reported a significant decrease in symptoms of anxiety and depression or mood [33,34,36,37,65] in lung, liver, and kidney transplant candidates. However, studies differed regarding duration (8-12 weeks), modality (group vs. individual; remote vs. in person), and most studies had small sample sizes (n = 29 to n = 71) (Table 4).…”

Rehabilitative goals for patients undergoing lung retransplantation

“…When approaching retransplantation, patients often face a clinical deterioration that can be demoralizing. In this regard, it has been found that an 8-week cognitive behavioral stress management and relaxation training intervention is excellent for patients requiring solid organ transplantation [ 16 ]. Directing rehabilitative interventions towards goals that focus on maintaining function and avoiding physical deconditioning is of paramount importance in the preoperative period before LRT.…”