O14 Home-based, virtually delivered prehabalitation for liver transplantation can improve both quality of life (QOL) and liver frailty index (LFI) scores

<h3>Background</h3> It is recognised that malnutrition, sarcopenia, and physical frailty significantly increases morbidity and mortality before and after liver transplantation. The aim of prehabilitation is to optimise physical fitness of patients prior to major surgeries. Several feasibility studies have demonstrated a potential benefit in those awaiting liver transplantation. QuestPrehab™ delivers prehabilitation virtually through three key elements: exercise, nutrition and psychological support. As well as tracking their dietary intake, logging exercises, engaging with mindfulness, patients have access to group exercises and peer support. The benefits of QuestPrehab™ has been demonstrated in patients with breast cancer. We have used QuestPrehab™ for patients referred to the South West Liver Unit for liver transplant assessment with the aim of improving fitness for transplant and improving patients quality of life. <h3>Methods</h3> We referred 43 patients undergoing liver transplant assessment for QuestPrehab™. Patients were enrolled in the programme for six months. We measured eight outcomes pre and post prehabilitation: quality of life (QOL), anxiety score, depression score, general self-efficacy, hand grip strength (HGS), 5 sit to stand (5STS), 30-second balance test, and liver frailty index (LFI). <h3>Results</h3> Of the 43 patients referred, two were not suitable for QuestPrehab™. Seven patients did not enter the programme, with reasons including hospitalisation, death on the transplant waiting list, not being listed, successful transplantation, or hepatic encephalopathy. 13 have completed the programme and 12 remain in programme. Three were unable to complete the programme, and one died. We are attempting engagement with four patients, and one is awaiting to be assessed. Of those that completed the programme, we found a 10.4% improvement in LFI, 21.9% increase in HGS, and a 25.1% decrease in the time taken to perform 5 sit to stand manoeuvres (figure 1). Additionally, there was a 43% increase in self-reported QOL using EQ-VAS (EuroQoL Visual Analogue Scale) tool and a reduction in depression by 57% using the HADS (Hospital Anxiety and Depression scale) tool. <h3>Conclusion</h3> We have demonstrated a virtually delivered prehabilitation programme encompassing exercise, nutrition and psychological support can be delivered to a group of patients undergoing liver transplant assessment, without need for in-person interactions. Patients responded positively to the programme with regards to receiving active encouragement, improving strength and fitness, as well as monitoring their dietary intake. This pilot shows promising results for improving QOL and LFI for patients awaiting liver transplantation. Through virtual delivery, we managed to save 3762 miles in total. <h3>References</h3> Williams FR, Milliken D, Lai JC, Armstrong MJ. Assessment of the frail patient with end-stage liver disease: a practical overview of sarcopenia, physical function, and disability. <i>Hepatology Communications</i>. 2021;5(6):923–937. Jetten WD, Hogenbirk RN, Van Meeteren NL, Cuperus FJ, Klaase JM, De Jong R. Physical effects, safety and feasibility of prehabilitation in patients awaiting orthotopic liver transplantation, a systematic review. <i>Transplant International</i>. 2022;35:10330. Morkane CM, Kearney O, Bruce DA, Melikian CN, Martin DS. An outpatient hospital-based exercise training program for patients with cirrhotic liver disease awaiting transplantation: a feasibility trial. <i>Transplantation</i>. 2020;104(1):97–103. Lai JC, Segev DL, McCulloch CE, Covinsky KE, Dodge JL, Feng S. Physical frailty after liver transplantation. <i>American Journal of Transplantation</i>. 2018;18(8):1986–1994. Wu F, Laza-Cagigas R, Pagarkar A, Olaoke A, El Gammal M, Rampal T. The feasibility of prehabilitation as part of the breast cancer treatment pathway. <i>PM&amp;R</i>. 2021;13(11):1237–1246.