Post Lung Transplant Rehabilitation Program During the COVID Era

PURPOSE: The post lung transplant (LTx) rehabilitation program was required to rapidly reduce service provision during coronavirus (COVID 19) pandemic. This was achieved by minimising the group format, number of sessions and type of exercises performed, as it transitioned from a centre-based supervised program to a home based program. Aim: This retrospective study aimed to compare standardised outcome measures for LTx recipients from the non- COVID era (2019) to those from LTx recipients who completed rehabilitation at home during the COVID (2020). Study population included post LTx males & females > 18 years who underwent BSLTx or SLTx at The Alfred from March to August 2020, compared to a matched cohort transplanted between March-August in 2019. METHODS: The 2019 post LTx rehabilitation program was a thrice weekly, 8 weekly supervised, group format consisting of 30 minutes cardiovascular training on treadmill and exercise bike plus resistance training for upper and lower limbs. During 2020 (COVID) the rehabilitation program was shortened to a twice weekly, individual, 2 - 3 week format followed by a home exercise program (HEP) using exercise diary and weekly phone follow up. COVID era patients were discharged from the gym to the HEP as soon as they were safe to exercise independently. Outcome measures -six minute walk test (6MWT), grip strength (GS) on a dynamometer and a sit to stand test in one minute (STS) were taken on entry to the rehabilitation program and three months post (3/12P). Quality of life (QOL) questionnaire was completed. RESULTS: Groups were well matched for LTx age, surgery and length of hospital stay. After 3 months, COVID era participants had not significantly increased 6MWD compared to Non -COVID era (-183m (-230 to -137)) STS improved significantly in both Non-COVID (p=0.001) and COVID (p=0.008) . There was no improvement in QOL or GS for COVID group, but significant improvements for non-COVID QOL (p=0.001) and GS (p=0.05). CONCLUSION: The change to a HEP in COVID era may have negatively impacted the improvement in functional exercise capacity, GS and QOL for those LTx recipients. Further research is required to develop an optimal HEP model.