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Florian J, Watte G, Teixeira PJZ, Altmayer S, Schio SM, Sanchez LB, Nascimento DZ, Camargo SM, Perin FA, Camargo JDJ, Felicetti JC, Moreira JDS. Pulmonary rehabilitation improves survival in patients with idiopathic pulmonary fibrosis undergoing lung transplantation. Sci Rep 2019; 9:9347. [PMID: 31249363 PMCID: PMC6597536 DOI: 10.1038/s41598-019-45828-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
This study was conducted to evaluate whether a pulmonary rehabilitation program (PRP) is independently associated with survival in patients with idiopathic pulmonary fibrosis (IPF) undergoing lung transplant (LTx). This quasi-experimental study included 89 patients who underwent LTx due to IPF. Thirty-two completed all 36 sessions in a PRP while on the waiting list for LTx (PRP group), and 53 completed fewer than 36 sessions (controls). Survival after LTx was the main outcome; invasive mechanical ventilation (IMV), length of stay (LOS) in intensive care unit (ICU) and in hospital were secondary outcomes. Kaplan-Meier curves and Cox regression models were used in survival analyses. Cox regression models showed that the PRP group had a reduced 54.0% (hazard ratio = 0.464, 95% confidence interval 0.222–0.970, p = 0.041) risk of death. A lower number of patients in the PRP group required IMV for more than 24 hours after LTx (9.0% vs. 41.6% p = 0.001). This group also spent a mean of 5 days less in the ICU (p = 0.004) and 5 days less in hospital (p = 0.046). In conclusion, PRP PRP completion halved the risk of cumulative mortality in patients with IPF undergoing unilateral LTx
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Affiliation(s)
- Juliessa Florian
- Postgraduate Program in Pulmonology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.,Pulmonary Rehabilitation Program, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Guilherme Watte
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil. .,Pulmonary Rehabilitation Program, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.
| | - Paulo José Zimermann Teixeira
- Pulmonary Rehabilitation Program, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.,Departament of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Stephan Altmayer
- Medical Imaging Research Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Sadi Marcelo Schio
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Letícia Beatriz Sanchez
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Douglas Zaione Nascimento
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | | | - Fabiola Adélia Perin
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - José de Jesus Camargo
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - José Carlos Felicetti
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - José da Silva Moreira
- Postgraduate Program in Pulmonology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Shiner CT, Woodbridge G, Skalicky DA, Faux SG. Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes. PM R 2019; 11:849-857. [DOI: 10.1002/pmrj.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/22/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Christine T. Shiner
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
| | - Genevieve Woodbridge
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
| | - David A. Skalicky
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
| | - Steven G. Faux
- Department of RehabilitationSt Vincent's Hospital SydneyDarlinghurstNSW Australia
- St Vincent's Clinical SchoolFaculty of Medicine, University of New South Wales Sydney NSW Australia
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Song JH, Park JE, Lee SC, Kim S, Lee DH, Kim EK, Kim SY, Shin JC, Lee JG, Paik HC, Park MS. Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience. Acute Crit Care 2018; 33:146-153. [PMID: 31723878 PMCID: PMC6786695 DOI: 10.4266/acc.2018.00129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation. Methods We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4). Results The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4. Conclusions Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.
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Affiliation(s)
- Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Eun Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sarang Kim
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyung Lee
- Division of Nursing, Pediatric Intensive Care Unit, Severance Hospital, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Nursing, Neurointensive Care Unit, Severance Hospital, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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van Adrichem EJ, Dekker R, Krijnen WP, Verschuuren EAM, Dijkstra PU, van der Schans CP. Physical Activity, Sedentary Time, and Associated Factors in Recipients of Solid-Organ Transplantation. Phys Ther 2018; 98:646-657. [PMID: 29757444 DOI: 10.1093/ptj/pzy055] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/25/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Short-term survival after solid-organ transplantation has substantially improved, and the focus has shifted to long-term survival, including the role of physical activity (PA). Knowledge about PA and sedentary time in recipients of solid-organ transplantation is limited, and identification of the levels and associated factors is necessary for intervention development. OBJECTIVE The objectives of this study were to investigate the level of PA and sedentary time in recipients of solid-organ transplantation and to identify factors associated with these behaviors. DESIGN The design consisted of a cross-sectional survey. METHODS Questionnaires on PA level, sedentary time, and potential associated factors were used for recipients of solid-organ transplantation (kidney, liver, lung, and heart [N = 656]). Multiple regression analyses with a variable selection procedure were used. RESULTS Fewer than 60% of the recipients fulfilled the PA guideline. Factors significantly associated with a lower level of PA included being a woman, younger age (nonlinear), not actively working or being retired, physical limitations, and low expectations and self-confidence. Factors significantly associated with less sedentary time included exercise self-efficacy and not actively working or being retired. Significantly associated with more sedentary time were a high education level, fear of negative effects, physical limitations, and the motivator "health and physical outcomes." The type of transplantation did not significantly influence either of the outcome measures. LIMITATIONS The design did not allow for causal inferences to be made. The studied associated factors were limited to individual and interpersonal factors. Self-reported measures of PA and sedentary time were used. CONCLUSIONS In intervention development directed at increasing the level of PA and reducing sedentary time in recipients of solid-organ transplantation, attention should be paid to physical limitations, fear of negative effects, low expectations and self-confidence, health and physical outcomes, and exercise self-efficacy.
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Affiliation(s)
- Edwin J van Adrichem
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen, Groningen, the Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; and University Medical Center Groningen, Groningen Transplant Center, University of Groningen. Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Rienk Dekker
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen; and University Medical Center Groningen, Center of Sports Medicine, University of Groningen
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences
| | - Erik A M Verschuuren
- University Medical Center Groningen, Groningen Transplant Center, University of Groningen; and University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen
| | - Pieter U Dijkstra
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen; and University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, University of Groningen
| | - Cees P van der Schans
- University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen; and Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences
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Mejia-Downs A, DiPerna C, Shank C, Johnson R, Rice D, Hage C. Predictors of Long-Term Exercise Capacity in Patients Who Have Had Lung Transplantation. Prog Transplant 2018; 28:198-205. [PMID: 29898639 DOI: 10.1177/1526924818781564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Six-minute walk distance (6MWD) is a widely used surrogate for exercise capacity in patients both pre- and post-lung transplant. Multiple factors have been suggested to influence exercise capacity. RESEARCH QUESTIONS This study sought to determine the change in exercise capacity over time and factors that influence long-term exercise capacity. DESIGN Data were collected prospectively on lung transplant recipients from 1 center. The 6MWD was measured preoperatively and at the 6- and 12-month clinic visits postoperatively. The Enright equation was used to calculate patients' percentage predicted 6MWD. The change in 6MWD over time was calculated, and multiple factors affecting 6MWD were analyzed, including predictors of 6MWD at 6 and 12 months posttransplant. RESULTS Sixty lung transplant recipients were enrolled. Significant improvement in 6MWD was found between pretransplant and hospital discharge and between hospital discharge and 6 months posttransplant. The percentage predicted 6MWD improved significantly from pretransplant to 6 months and to 12 months posttransplant. Factors associated with 6MWD were sex, diagnosis, graft type, and age. Factors predicting long-term exercise capacity included 6MWD at referral, pretransplant, and hospital discharge; pulmonary diagnosis; and type of transplant. CONCLUSION The 6MWD provided useful information about patients' exercise capacity during phases of lung transplantation. The percentage predicted for each patient was found to be a more valuable measure than absolute 6MWD. Intensive, individualized training posttransplant is essential to optimize exercise capacity for this population.
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Affiliation(s)
- Anne Mejia-Downs
- 1 Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA.,2 Department of Rehabilitation Services, Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Christen DiPerna
- 2 Department of Rehabilitation Services, Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Cori Shank
- 2 Department of Rehabilitation Services, Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Rebecca Johnson
- 2 Department of Rehabilitation Services, Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Danielle Rice
- 2 Department of Rehabilitation Services, Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Chadi Hage
- 3 Indiana University Health, Pulmonary and Critical Care Medicine, Thoracic Transplantation Program, Indianapolis, IN, USA
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Zhou Y, Zhou X, Zhou W, Pang Q, Wang Z. The protective effect of dexmedetomidine in a rat ex vivo lung model of ischemia-reperfusion injury. Acta Cir Bras 2018; 33:1-13. [PMID: 29412228 DOI: 10.1590/s0102-865020180010000001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/19/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the effect of dexmedetomidine (Dex) in a rat ex vivo lung model of ischemia-reperfusion injury. METHODS An IL-2 ex vivo lung perfusion system was used to establish a rat ex vivo lung model of ischemia-reperfusion injury. Drugs were added to the perfusion solution for reperfusion. Lung injury was assessed by histopathological changes, airway pressure (Res), lung compliance (Compl), perfusion flow (Flow), pulmonary venous oxygen partial pressure (PaO2), and lung wet/dry (W/D) weight ratio. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), 78 kDa glucose-regulated protein (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) were measured, respectively. RESULTS The introduction of Dex attenuated the post-ischemia-reperfusion lung damage and MDA level, improved lung histology, W/D ratio, lung injury scores and SOD activity. Decreased mRNA and protein levels of GRP78 and CHOP compared with the IR group were observed after Dex treatment. The effect of Dex was dosage-dependence and a high dose of Dex (10 nM) was shown to confer the strongest protective effect against lung damage (P<0.05). Yohimbine, an α2 receptor antagonist, significantly reversed the protective effect of Dex in lung tissues (P<0.05). CONCLUSION Dex reduced ischemia-reperfusion injury in rat ex vivo lungs.
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Affiliation(s)
- Yan Zhou
- MD, Attending physician, Department of Anesthesiology, Affiliated Wuxi People's Hospital, Nanjing Medical University, China. Acquisiton, analysis and interpretaton of data; manuscript preparation
| | - Xinqiao Zhou
- MD, Resident, Department of Anesthesiology, Affiliated Wuxi People's Hospital, Nanjing Medical University, China. Technical procedures, acquisition of data
| | - Wenjuan Zhou
- MD, Resident, Department of Anesthesiology, Affiliated Wuxi People's Hospital, Nanjing Medical University, China. Technical procedures
| | - Qingfeng Pang
- IVPhD, Full Professor, Department of Basic Medicine, Wuxi Medical School, Jiangnan University, China. Technical procedures
| | - Zhiping Wang
- PhD, Full Professor, Department of Anesthesiology, Affiliated Wuxi People's Hospital, Nanjing Medical University, China. Conception and design of the study, manuscript preparation, final approval
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Wickerson L, Rozenberg D, Janaudis-Ferreira T, Deliva R, Lo V, Beauchamp G, Helm D, Gottesman C, Mendes P, Vieira L, Herridge M, Singer LG, Mathur S. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016; 6:517-31. [PMID: 27683630 PMCID: PMC5036121 DOI: 10.5500/wjt.v6.i3.517] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and post-transplant patient care and rehabilitation researchers.
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Seiler A, Klaghofer R, Ture M, Komossa K, Martin-Soelch C, Jenewein J. A systematic review of health-related quality of life and psychological outcomes after lung transplantation. J Heart Lung Transplant 2015; 35:195-202. [PMID: 26403492 DOI: 10.1016/j.healun.2015.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) aims to reduce physical disability and mental distress, extend survival, and improve health-related quality of life (HRQoL). In this systematic review we aimed to: (1) augment evidence regarding measures to assess HRQoL and psychological outcomes after LTx; and (2) summarize HRQoL and psychological outcomes after LTx. METHODS Validated and standardized instruments with well-known psychometric properties used for assessing HRQoL and psychological outcomes after LTx were identified by means of comprehensive literature searches of PsychINFO and Medline/PubMed, up through March 2014, using the following search terms in various combinations: lung transplantation; physical functioning; symptom experience; mental health; anxiety; depression; distress; social functioning; life satisfaction; and health-related quality of life. RESULTS The search strategy identified 371 titles and abstracts. Of these, 279 were retrieved for further assessment and 63 articles selected for final review. Thirty-nine studies were found for HRQoL, 15 for physical functioning, 5 for mental health and 4 for social functioning. A total of 50 psychometric instruments were encountered. CONCLUSIONS Considerable heterogeneity exists in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, the studies generally point to significant improvements in both mental health and HRQoL post-transplant. Further research is warranted utilizing consistent outcome measures, including LTx-specific measures and longitudinal study designs.
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Affiliation(s)
- Annina Seiler
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland.
| | - Richard Klaghofer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Maria Ture
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Katja Komossa
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | | | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
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Tang M, Mawji N, Chung S, Brijlal R, Lim Sze How JK, Wickerson L, Rozenberg D, Singer LG, Mathur S, Janaudis-Ferreira T. Factors affecting discharge destination following lung transplantation. Clin Transplant 2015; 29:581-7. [PMID: 25918985 DOI: 10.1111/ctr.12556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lung transplant (LT) recipients requiring additional care may be referred to inpatient rehabilitation prior to discharge home. This study seeks to describe discharge destinations following LT, compare the characteristics of patients discharged to different destinations, and identify the predictors of discharge destination. METHODS Retrospective study of 243 LT recipients who survived to hospital discharge between 2006 and 2009. LT recipients were compared based on discharge destination on data pertaining to demographics, clinical characteristics, and healthcare utilization. RESULTS Of the 243 recipients, 197 (81%) were discharged home, 42 (17%) to inpatient rehabilitation, and 4 (2%) to other medical facilities. Age, pulmonary diagnosis, most recent six-minute walk distance (6 MWD) prior to transplant, pre-transplant mechanical ventilation, priority listing status, pre- and post-transplant intensive care unit length of stay (ICU LOS), post-transplant LOS, total LOS, and participation in pre-transplant rehabilitation were statistically different between patients that were discharged home versus inpatient rehabilitation. Age, most recent 6 MWD prior to transplant, pre-transplant mechanical ventilation, and total LOS were found to be independent predictors of discharge destination. CONCLUSION Clinical factors can help identify patients more likely to require inpatient rehabilitation. Identification of these factors has the potential to facilitate early discharge planning and optimize continuity of care.
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Affiliation(s)
- Min Tang
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nadir Mawji
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Chung
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brijlal
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Lisa Wickerson
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada
| | - Lianne G Singer
- Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada
| | - Sunita Mathur
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Respiratory Medicine, West Park Health Centre, Toronto, ON, Canada
| | - Tania Janaudis-Ferreira
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Respiratory Medicine, West Park Health Centre, Toronto, ON, Canada
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Predicting 6-minute walking distance in recipients of lung transplantation: longitudinal study of 108 patients. Phys Ther 2015; 95:720-9. [PMID: 25524871 DOI: 10.2522/ptj.20140001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exercise capacity, muscle function, and physical activity levels remain reduced in recipients of lung transplantation. Factors associated with this deficiency in functional exercise capacity have not been studied longitudinally. OBJECTIVE The study aims were to analyze the longitudinal change in 6-minute walking distance and to identify factors contributing to this change. DESIGN This was a longitudinal historical cohort study. METHODS Data from patients who received a lung transplantation between March 2003 and March 2013 were analyzed for the change in 6-minute walking distance and contributing factors at screening, discharge, and 6 and 12 months after transplantation. Linear mixed-model and logistic regression analyses were performed with data on characteristics of patients, diagnosis, waiting list time, length of hospital stay, rejection, lung function, and peripheral muscle strength. RESULTS Data from 108 recipients were included. Factors predicting 6-minute walking distance were measurement moment, diagnosis, sex, quadriceps muscle and grip strength, forced expiratory volume in 1 second (percentage of predicted), and length of hospital stay. After transplantation, 6-minute walking distance increased considerably. This initial increase was not continued between 6 and 12 months. At 12 months after lung transplantation, 58.3% of recipients did not reach the cutoff point of 82% of the predicted 6-minute walking distance. Logistic regression demonstrated that discharge values for forced expiratory volume in 1 second and quadriceps or grip strength were predictive for reaching this criterion. LIMITATIONS Study limitations included lack of knowledge on the course of disease during the waiting list period, type and frequency of physical therapy after transplantation, and number of missing data points. CONCLUSIONS Peripheral muscle strength predicted 6-minute walking distance; this finding suggests that quadriceps strength training should be included in physical training to increase functional exercise capacity. Attention should be paid to further increasing 6-minute walking distance between 6 and 12 months after transplantation.
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Kim SY, Wong AHM, Abou Neel EA, Chrzanowski W, Chan HK. The future perspectives of natural materials for pulmonary drug delivery and lung tissue engineering. Expert Opin Drug Deliv 2014; 12:869-87. [DOI: 10.1517/17425247.2015.993314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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