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Tarrant BJ, Quinn E, Robinson R, Poulsen M, Fuller L, Snell G, Thompson BR, Button BM, Holland AE. Post-operative, inpatient rehabilitation after lung transplant evaluation (PIRATE): A feasibility randomized controlled trial. Physiother Theory Pract 2022:1-11. [PMID: 35193445 DOI: 10.1080/09593985.2022.2041779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative rehabilitation is crucial following lung transplantation (LTx); however, it is unclear whether intensive rehabilitation is feasible to deliver in the acute setting. We aimed to establish the feasibility and safety of intensive acute physiotherapy post-LTx. METHODS This feasibility trial randomized 40 adults following bilateral sequential LTx to either standard (once-daily) or intensive (twice-daily) physiotherapy. Primary outcomes were feasibility (recruitment and delivery of intensive intervention) and safety. Secondary outcomes included six-minute walk test; 60-second sit-to-stand; grip strength; physical activity; pain; EQ-5D-5L; length of stay; and readmissions. Data were collected at baseline, week 3, and week 10 post-LTx. ClinicalTrials.gov #NCT03095859. RESULTS Of 83 LTx completed during the trial, 49% were eligible and 48% provided consent. Median age was 61 years {range 18-70}; waitlist time 85 days [IQR 35-187]. Median time to first mobilization was 2 days [2-3]. Both groups received a median of 10 [7-14] standard interventions post-randomization. A median of 9 [6-18] individual intensive interventions were attempted (86% successful), the most common barrier being medical procedures/investigations (67%). No intervention-related adverse events or between-group differences in secondary outcomes were observed. CONCLUSIONS Acute, intensive physiotherapy was feasible and safe post-LTx. This trial provides data to underpin definitive trials to establish efficacy.
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Affiliation(s)
- Benjamin J Tarrant
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Quinn
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Robinson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Megan Poulsen
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Louise Fuller
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Greg Snell
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Bruce R Thompson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Brenda M Button
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
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Tarrant BJ, Robinson R, Le Maitre C, Poulsen M, Corbett M, Snell G, Thompson BR, Button BM, Holland AE. The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation. Phys Ther 2020; 100:1217-1228. [PMID: 32280975 DOI: 10.1093/ptj/pzaa057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx. METHODS This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission. RESULTS Median (interquartile range) age was 62 (56-67) years; time post-LTx was 5 (5-7) days postoperative and 696 (244-1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness. CONCLUSIONS The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively. IMPACT The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.
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Affiliation(s)
- Benjamin J Tarrant
- Physiotherapy Department, The Alfred, Alfred Health, Philip Block, Level 4, 55 Commercial Road, Melbourne, Victoria, Australia 3004, and School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria Australia
| | | | | | | | | | - Greg Snell
- Lung Transplant Services, The Alfred, Alfred Health and Allergy, Immunology, and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- Physiology Services, The Alfred, Alfred Health and School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Brenda M Button
- Physiotherapy Department, The Alfred, Alfred Health and Monash University
| | - Anne E Holland
- Physiotherapy Department, The Alfred, Alfred Health, Monash University and La Trobe University
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Polastri M, Pacilli AMG, Dell'Amore A. Physiotherapy and lung transplantation: in the folds of history. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2019.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Physiotherapist, Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St Orsola University Hospital, Bologna, Italy
| | - Angela Maria Grazia Pacilli
- Pulmonologist, Department of Specialistic-Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Andrea Dell'Amore
- Thoracic Surgeon, Department of Cardiac-Thoracic-Vascular Diseases, Unit of Thoracic Surgery, St Orsola University Hospital, Bologna, Italy
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Tarrant BJ, Snell G, Ivulich S, Button B, Thompson B, Holland A. Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial. Transpl Int 2019; 32:603-613. [DOI: 10.1111/tri.13400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/09/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gregory Snell
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Steven Ivulich
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Brenda Button
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Bruce Thompson
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Anne Holland
- Alfred Health; Melbourne Vic. Australia
- La Trobe University; Melbourne Vic. Australia
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