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The Road to Recovery - Rehabilitation after Lung Transplantation


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Louise Fuller, PT
Alfred Hospital
Melbourne, Australia
L.fuller@alfred.org.au



The definition of rehabilitation is the act of restoring something to its original state and comes from the latin re meaning "again" and habitare meaning "make fit".

Exercise rehabilitation is an established element of care after lung transplantation (LTX). There is evidence about improving functional exercise capacity & muscle strength, but what about the patients' experience of post transplantation rehabilitation? What elements of the rehabilitation program are more useful to them? It can be challenging commencing an exercise program for many patients given the reduction in physical activity pre transplantation.

Acute post LTX rehabilitation programs vary in duration and composition worldwide. These can range from in patient to outpatient or home based programs. There is little supporting evidence to establish the exact composition of exercise rehabilitation programs.

Our current program of 36 supervised sessions has an average attendance rate of 85%. It is undertaken for all post lung transplantation recipients once they have achieved outpatient status (average time from transplant is 20 days) Goal of rehabilitation should be to return patients to peer matched normal life activities including return to school, work, sport or community work. A combination of aerobic training and strength training is performed in the gym, supervised by physical therapists and allied health assistants. Exercise prescription is patient tailored and progressive. Strict infection control procedures are followed.

Recent qualitative research has highlighted that the rehabilitation program in this format is highly valued by patients. There is an overwhelming desire to return to normal activities and rehabilitation is considered as the vehicle to enable this to happen. Whilst the musculoskeletal improvements are more obvious, it is the psychological improvements that are more surprising. There is a sense of having exceeded expectations and achieving a physical level that empowered patients to continue to exercise.

Exercising in a group environment provides peer support, motivation and camaraderie in a friendly, informal atmosphere whilst still allowing access to professional guidance. There is also a strong sense of community within the group and a heighten sense of achievement on completion of the program.

Interruption to rehabilitation either from pre-existing musculoskeletal co-morbidities or medical setbacks post-transplant is particularly concerning to the patients. Frustration at missing gym sessions increased anxiety about delays in goal attainment and particular attention needs to be paid to the musculoskeletal assessment pre transplant to eliminate these co-morbidities.

These patient experiences and expectations have impact on our rehabilitation program design. Educating patients about realistic physical goals setting and constant re-assessment of their goals is important particularly considering the physiological changes or drug side effects on skeletal muscle and its subsequent ability to exercise.

From the patients' perspective, the rehabilitation program design needs to include peer support and an opportunity to interact with other transplant patients, either in a group exercise setting or an informal debriefing session.

Tailoring our rehabilitation programs to the patients expectations will certainly again make them fit! ■

Disclosure Statement: The author has no conflicts of interest to disclose


References:

  1. Fuller, L.M., et al., Patients' expectations and experiences of rehabilitation following lung transplantation. Clinical Transplantation, 2014. 28(2): p. 252-258.
  2. Langer, D., et al., Exercise training after lung transplantation improves participation in daily activity: a randomized controlled trial. American Journal of Transplantation, 2012. 12(6): p. 1584-92.
  3. Reinsma, G.D., et al., Limiting factors of exercise performance 1 year after lung transplantation. Journal of Heart & Lung Transplantation, 2006. 25(11): p. 1310-6.
  4. Spruit, M.A., et al., An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 2013. 188(8): p. e13-e64.
  5. Wang, X.N., et al., Skeletal muscle oxidative capacity, fiber type, and metabolites after lung transplantation. American Journal of Respiratory & Critical Care Medicine, 1999. 160(1): p. 57-63.
  6. Wickerson, L., S. Mathur, and D. Brooks, Exercise training after lung transplantation: A systematic review. Journal of Heart and Lung Transplantation. 2010 29(5): p. 497-503.



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