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Moshe R1,2, Kodesh E2, Kremer M3
1Rabin Medical Centre, Beilinson Hospital, The Physiotherapy Department, Petach-Tikva, Israel, 2University of Haifa, Physiotherapy, Haifa, Israel, 3Rabin Medical Centre, Beilinson Hospital, Lung and Allergy Department, Petach-Tikva, Israel
Background: Although lung function improves significantly after lung transplantation (LT), recipients often have exercise intolerance, low muscle mass, poor strength and reduced quality of life (QOL). Pulmonary rehabilitation (PR) of lung transplant recipients helps optimise physical functioning and recovery.
Purpose: This retrospective study aims to describe and compare the results of functional outcome measures and survival in patients participating in a PR program to those who did not take part in the program. It predicts survival based on result parameters and group association.
Methods: A retrospective study examining records of 316 patients that underwent LT between 2000-2015 at Beilinson Hospital was designed. The following data was collected: demographic, underlying disease, Pulmonary Function (PF), cardiopulmonary exercise test (CPET) and 6 Minute Walk Test (6MWT) results, participation in a rehabilitation program and survival.
In order to examine the effect of time since transplant, a one-way analysis of variance (ANOVA) with repeated measurements mixed-mode was used. To examine the effect of participation in PR on outcome measurements a comparison between the rehabilitated and not-rehabilitated groups was made with a bi-directional 2*2 ANOVA with a repeated measurement mixed model. To predict survival by result parameters and association with the rehabilitation group, a Cox Proportional Hazards regression model was used.
Results: Data from 316 patients was collected, 56.96% (n=180) were men. The mean age was 54.45±12.44 years. Median survival rate was 1069 days. PF improved in the 6-12 months after the transplant, and remained better than pre-transplant for 4-5 years (P 0.0001). A similar trend was found in the CPET (P 0.05) and the 6MWT (P 0.0001). 106 recipients participated in a PR program, and there were more survivors five years post-transplant among participants (78%) (P 0.001). The predictive mortality model showed that the odds of death for those who underwent rehabilitation were 67% lower than those in the non-rehabilitation group.
Conclusion(s): As far as we know, this is the first comparison of lung transplant recipients participating in PR with recipients who did not participate. After the transplant, the PF tests, CPET and 6MWT improved compared to pre-transplant results and remained stable for up to 5 years. No differences were found between those participating in rehabilitation and those who did not for CEPT and 6MWT. Recipients that were rehabilitated had a longer post-transplant survival time, and the chance of 5-year survival increased by 67%. We cannot rule out the role of other variables not found in the medical records, such as the extent of daily physical activity, participation in community activities, and quality of life. Further research is required to confirm the positive impacts of PR.
Implications: Information about the better survival rates of patients participating PR should be administered to the patients and the multidisciplinary staff. Therefore, increasing patients compliance with PR and their survival odds. As other studies show, it can also improve the quality of life of the PR participants. Furthermore, when there is more data to support these findings, it can help in changing the policy of the government concerning PR programs funding and accessibility.
Keywords: Pulmonary Rehabilitation, Lung Transplant, Survival of Lung Transplant patients
Funding acknowledgements: The research has been partially supported by the research fund of the lung department at Beilinson hospital.
Purpose: This retrospective study aims to describe and compare the results of functional outcome measures and survival in patients participating in a PR program to those who did not take part in the program. It predicts survival based on result parameters and group association.
Methods: A retrospective study examining records of 316 patients that underwent LT between 2000-2015 at Beilinson Hospital was designed. The following data was collected: demographic, underlying disease, Pulmonary Function (PF), cardiopulmonary exercise test (CPET) and 6 Minute Walk Test (6MWT) results, participation in a rehabilitation program and survival.
In order to examine the effect of time since transplant, a one-way analysis of variance (ANOVA) with repeated measurements mixed-mode was used. To examine the effect of participation in PR on outcome measurements a comparison between the rehabilitated and not-rehabilitated groups was made with a bi-directional 2*2 ANOVA with a repeated measurement mixed model. To predict survival by result parameters and association with the rehabilitation group, a Cox Proportional Hazards regression model was used.
Results: Data from 316 patients was collected, 56.96% (n=180) were men. The mean age was 54.45±12.44 years. Median survival rate was 1069 days. PF improved in the 6-12 months after the transplant, and remained better than pre-transplant for 4-5 years (P 0.0001). A similar trend was found in the CPET (P 0.05) and the 6MWT (P 0.0001). 106 recipients participated in a PR program, and there were more survivors five years post-transplant among participants (78%) (P 0.001). The predictive mortality model showed that the odds of death for those who underwent rehabilitation were 67% lower than those in the non-rehabilitation group.
Conclusion(s): As far as we know, this is the first comparison of lung transplant recipients participating in PR with recipients who did not participate. After the transplant, the PF tests, CPET and 6MWT improved compared to pre-transplant results and remained stable for up to 5 years. No differences were found between those participating in rehabilitation and those who did not for CEPT and 6MWT. Recipients that were rehabilitated had a longer post-transplant survival time, and the chance of 5-year survival increased by 67%. We cannot rule out the role of other variables not found in the medical records, such as the extent of daily physical activity, participation in community activities, and quality of life. Further research is required to confirm the positive impacts of PR.
Implications: Information about the better survival rates of patients participating PR should be administered to the patients and the multidisciplinary staff. Therefore, increasing patients compliance with PR and their survival odds. As other studies show, it can also improve the quality of life of the PR participants. Furthermore, when there is more data to support these findings, it can help in changing the policy of the government concerning PR programs funding and accessibility.
Keywords: Pulmonary Rehabilitation, Lung Transplant, Survival of Lung Transplant patients
Funding acknowledgements: The research has been partially supported by the research fund of the lung department at Beilinson hospital.
Topic: Cardiorespiratory; Disability & rehabilitation; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Rabin Medical Centre, Beilinson Hospital, Petach-Tikva, Israel
Ethics committee: Helsinki Ethics Committee
Ethics number: 0753-15-RMC
All authors, affiliations and abstracts have been published as submitted.
