Perspire: Preventing Rehospitalization in Lung Transplant Recipients Utilizing Individualized Rehabilitation Prescriptions

Abstract

Changes in US organ allocation have prioritized lung transplant for sicker, older patients, leading to increased frailty and poorer health-related quality of life (QOL) after lung transplantation. Post-transplant frailty has been associated with rehospitalization and mortality. We sought to evaluate whether use of customized, app based rehabilitation early in the transplant recovery process could improve post-transplant frailty. We are performing a pilot multicenter single arm interventional trial of a digital "app"-based platform (Aidcube) to deliver an 8-week home-based pulmonary rehabilitation program. Transplant recipients are eligible for inclusion if they are deemed to be frail at the time of their incident transplant discharge based on Short Physical Performance Battery testing (SPPB<=9). At the time of discharge, patients undergo in-person training in exercise prescriptions and the Aidcube app is loaded on patients' smart phones. The app contains an individualized prescription for home-based rehabilitation based on in-person physical therapist assessments. The prescription is progressed based on response to exercises and subjective feedback. Our primary outcomes are change in SPPB, incidence of adverse events, and subject and provider app impressions. To date, 13 post-transplant patients have been enrolled in the study. The median SPPB at the time of enrollment was 4 (Interquartile range (IQR) 4, 7). Six patients have completed the full follow-up; the median SPPB at closeout was 9 (IQR 9, 10) with a median within person improvement of 4.5 (IQR 1, 5). To date, no adverse events have been reported with home app use. Patients generally reported positive experiences, including statements such as, "The patient is thrilled about walking. The patient attributes this success to the support of the program." and "'It's great and easy⋯It keeps me motivated to do what I should be doing." Limitations to app usage included incisional pain, admission to acute rehabilitation, and fatigue. Use of an app based pulmonary rehabilitation program targeting frailty after transplant is safe, generally appreciated by patients, and appears associated with improved frailty scores. Further research is needed to assess the impact of the app on rates of patient reported QOL, re-hospitalization and health care costs.