Pulmonary Physical Therapy Protocol to Evaluate Lung Transplant Candidates.

Frailty, characterized by a loss of strength, endurance, physical ability, and cognitive function, is prevalent in a lung transplant population. Frailty is associated with death or delisting before transplant and may be associated with post-transplant mortality. Lung transplant candidates have impairments in muscle function including reduced muscle mass, strength, and physical performance. The aim of this work is to develop a physical therapy protocol to evaluate physical frailty and performance, including respiratory and peripheral muscle strength; gait speed; fall risk; and perceived dyspnea in LTX candidates. In this single center prospective study, LTX candidates ≥40 years of age were included. The Short Physical Performance Battery (SPPB), respiratory muscle strength (maximal inspiratory pressure), peripheral muscle strength (handgrip and quadriceps isometric strength), gait speed (normal gait speed over 4 meters), chair stand test, Modified Borg Dyspnea Scale and Modified Medical Research Council Dyspnea Scale were evaluated as a baseline assessment. Of the 29 enrolled recipients (58% female, age 61±6.8 years), 8 subjects were frail (SPBB ≤7), 2 were pre-frail (SPBB 8-9) and 19 were non-frail (SPBB ≥10) at listing. Inspiratory muscle weakness as defined by lower than 70% of predicted normal values (PNV) existed in 15 (52%) LTX candidates. Handgrip muscle strength was below 80% of PNV in 11 (40%), and quadriceps strength was decreased for 24 subjects in the dominant leg and 22 in the non-dominant leg. Fourteen subjects were classified as household or limited community ambulators and 13 were classified as fall risks. Dyspnea with daily living activities was present in 4 subjects and was rated as moderate at rest in 8 individuals. We observed that physical performance limitations including respiratory and peripheral muscle weakness and frailty were prevalent in LTX candidates. Developing tools for frailty and physical performance assessment holds promise for improving patient outcomes in pre- and post-transplantation. Screening LTX candidates in a clinical setting will help stratify individuals that might have more specific rehabilitation needs pre- and post LTX, ultimately improving outcomes. Future aims of this project include assessing the same protocol in the LTX recipients and to investigate the association between variables. [ABSTRACT FROM AUTHOR]