To determine the feasibility of implementing a Telehealth exercise class post-alloBMT and its effect on physical and quality of life outcomes.
Retrospective, single site cohort study conducted at The Royal Melbourne Hospital. Patients aged ≥ 18 years, who underwent alloBMT within 100 days who had medical clearance to exercise were invited to participate for at least 12 weeks by the Clinical Nurse Consultant (CNC). They were provided with a portable oximeter, blood pressure cuff, dumbbells and resistance bands for home use. The twice-weekly, 60-minute Telehealth exercise classes were conducted by a physiotherapist and a BMT CNC. Daily suitability to exercise was determined by screening recent blood results, and vital observations. The class consisted of 15-20 minutes each of aerobic and resistance training tailored to individual fitness and mobility.
Data of all BMT unit admissions in the last three years were extracted from electronic medical records, including: demographics, pre- and post-transplant 6-minute walk test (6MWT) scores, transplant details and post-alloBMT complications. Class data included number of referrals, attendance, re-admissions, adverse events and pre-post EORTC QLQ-C30 (global health quality of life item) scores. Data were analysed descriptively and exploratory between group analyses were conducted using Stata18.5BE. The initial cohort of participants were also invited to provide written feedback at completion.
In total, 157 patient files were analysed between August 2021-August 2024. Fifty-six patients were referred to the Telehealth group, and 43 attended (77%). Exploratory analyses determined that there were no obvious differences between referred and non-referred patients (pre-6MWT, length of stay (LOS)). Participants were a median [IQR] 59 [51-63] years old at transplant, 44% female and had a median [IQR] inpatient LOS of 31 [28-37] days. The median [IQR] number of classes attended was 6 [3-12]. Eleven percent (n=5) sustained graft-versus-host disease and 53% (n=23) were re-admitted ≥1 time during their class admission for medical reasons. There were no adverse events during exercising. Exploratory analysis found no differences in EORTC QLQ-c30 (mean (SD) pre-class 57(22), post-class 48(18), t(17) = 1.21, p = 0.24) or 6MWT scores (mean (SD) pre-transplant 538(86), post-class 516(87), t(24) = 2.3, p=0.34). Written feedback was highly positive from group participants and included, “This group provides me with the motivation to keep going with exercise and see the gains I’ve made”.
People post-acute alloBMT are vulnerable and are at risk of complications or re-admission. Despite their fragility, those that attended the group were able to maintain their physical function. Participants highlighted the group’s role in fostering motivation for recovery.
In a vulnerable cohort, there were no adverse events to participating in group Telehealth rehabilitation. It can maintain physical function and motivation in post-alloBMT care. Reasons for non-referral were not obvious; further research includes investigating clinician’s perspectives on remote exercising in this population
Exercise
Bone Marrow Transplant
