Pulmonary Rehabilitation: Post-Lung Transplant Initiative

Background: At UPMC Presbyterian, impediments to referral for outpatient pulmonary rehab (OPR) following lung transplantation include extended length of stay, financial limitations, transportation issues, etc, particularly in patients who were being accommodated remotely from their homes. The pulmonary rehab staff collaborated with the lung transplant department to establish a rehabilitation protocol that would optimize therapeutic response in in a more efficient and shorter time frame than a traditional OPR program which consists of 2-3 days per week for up to 36 sessions. The goal of this new initiative was to allow participants to be discharged home faster post lung transplantation without compromising strength and endurance training goals. Methods: Upon discharge from the hospital after lung transplantation, the patient is scheduled within 2-3 days for OPR for 4 days per week for a total of 3-6 weeks. The patients are assessed weekly for grip strength, balance, frailty, and functional capacity to determine if they have met all criteria for discharge to a pulmonary rehab facility local to their home based on observation of a plateau in the patients’ weekly physical assessments. The OPR staff communicates with the transplant team on the patients’ progress throughout their program. Results: 23 patients were evaluated. Average duration in our program was 4.6 ± 1.1 weeks and 15.2 ± 5.2 sessions. 96% of patients met clinically important differences for 6-minute walk functional capacity (98 feet) with an average improvement of 412 ± 208 feet. Timed Up and Go (TUG) measurements improved in 87%, average 4.2 ± 4.3 s. METS obtained from a recumbent cycle improved in 87%, average 0.75 ± 0.72 METS. Frailty measurements which include grip strength improved in 74%, average 7 ± 7.6 kg; 5 chair stands improved in 83%, average 9.55 ± 9 s, and balance test improved in 100%. Conclusions: A modified more intensive OPR program was beneficial for the post-lung transplant population as evidenced by meaningful functional and frailty outcome measurements. Since implementation of the post-transplant initiative, patients are discharged home within 3-6 weeks. Post-lung transplant patients exhibited improvements in objective outcomes justifying the continuation of an intensive pulmonary rehab program.