Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

Abstract

BACKGROUND: Cardiopulmonary transplantation is becoming a more common treatment option for advanced heart and/or lung disease. Specialist rehabilitation programs may assist recovery and enhance functional independence following transplantation. OBJECTIVE: To quantify the outcomes of multidisciplinary inpatient rehabilitation following cardiopulmonary transplantation and describe cohort characteristics. DESIGN: Retrospective cohort study. SETTING: Subacute inpatient rehabilitation facility, located on-site at Australia's largest cardiopulmonary transplant center. PARTICIPANTS: Heart and/or lung transplant recipients (n = 116), admitted for multidisciplinary inpatient rehabilitation, between 2009 and 2016. INTERVENTIONS: All participants received multidisciplinary rehabilitation as part of their standard care. MAIN OUTCOME MEASUREMENTS: Participants' functional independence was scored using the Functional Independence Measure (FIM) upon rehabilitation admission and discharge. Physical measures of mobility and balance were assessed at the same time points, including the 6-minute walk test, 10 m walk, Timed Up and Go, and Berg Balance Scale. Process measures of interest included rehabilitation length of stay, interruptions to rehabilitation, and discharge destination. RESULTS: Average length-of-stay in rehabilitation was 26.9 ± 21.2 days (mean ± SD). FIM scores improved from 79.8 ± 20.3 on admission to 101.8 ± 29.1 at discharge (P < .001) for the pooled cohort. Physical measures of mobility and balance also improved: 6-minute walk test distances improved from 103.6 ± 80.1 to 183.2 ± 104.8 m (P < .001); Timed Up and Go results decreased from 26.4 ± 18.3 seconds to 16.5 ± 14.1 seconds (P < .001); and Berg Balance Scale scores increased from 26.8 ± 17.1 to 45.0 ± 9.4 (P < .001). Approximately one-third (33.6%) of admissions were interrupted by an acute medical complication; however, this did not preclude completion of rehabilitation or achievement of functional gains. Ninety-four percent of the cohort was discharged to a private residence following rehabilitation. No significant differences were observed between heart versus lung transplant recipients. CONCLUSIONS: For debilitated patients following heart and/or lung transplantation, physical function, mobility, and independence significantly improved following multidisciplinary inpatient rehabilitation. LEVEL OF EVIDENCE: III.