Resumption of valued activities in the first year post liver transplant

ABSTRACT Current practice in education of transplant recipients includes general guidelines about return to involvement in life activities emphasizing medical precautions during wound healing and avoidance of activities that present risk of infection or rejection. This approach assumes patients gradually resume pre-transplant involvement in life activities: an assumption that has not been tested. Using the Canadian Occupational Performance Measure, this cross-sectional descriptive pilot study (n = 20) explored differences in the performance of activities of daily living, instrumental activities of daily living, leisure, and productivity at three time periods within the first year. Results showed basic daily tasks are stable by the third month but some instrumental tasks declined by the end of the first year post transplant. Results indicated that there were significant differences in the Short Form-36 mental component score of the group performing "worse than expected" suggesting that preparation of recipients is needed to enable them to set realistic expectations. Results indicate the need for a longitudinal study of the resumption patterns of life activities for realistic expectations of recovery and guidelines for the treatment team.

Occupational therapy services to enable liver patients to thrive following transplantation

ABSTRACT Transplantation is the only viable treatment for end-stage liver failure. With advances in biomedicine and surgical technique, survival rates have improved and current research is beginning to focus on patient-related outcomes such as of quality of life (QOL) and life satisfaction. However, attention to the rehabilitation needs of those patients whose lives are saved, is lagging. Pretransplantation, there are serious strains to role function and limitations to mental and physical capacity. Following transplantation, the ability to perform once easy familiar tasks is difficult for a prolonged recovery period. Within a year many people do well, others do not. Little has been done for this latter group. The purpose of this article is to systematically describe the contributions occupational therapy can make to the people struggling with the challenges faced during the transplantation process. The first part presents a framework for understanding the impact of end-stage liver disease, then the transplant, and the subsequent recovery through the combination of two frameworks: the International Classification of Functioning Disability and Health (ICF) and the Model of Human Occupation. The second part of this article will present the implications for occupational therapists throughout seven stages: (1) decline in health, (2) organ failure, (3) referral for transplantation, (4) the waiting period, (5) the transplant surgery, (6) recovery, and (7) return of health. Attention to the needs of transplant recipients who lack the adaptive skills to resume productive lifestyles has the capacity to improve participation outcomes for this population.