Role of hybrid virtual pulmonary rehabilitation in improving performance status of patients eligible for lung transplantation

Pulmonary rehabilitation (PR) in chronic respiratory diseases improves symptoms, quality of life, and exercise capacity and has an integral role in lung transplantation (LT). Virtual PR has recently emerged to cater to patients who otherwise may not have regular access to PR. However, little is known about the effect of virtual PR strategies on candidates for LT. The primary objective was to study the effect of a protocolized hybrid PR program on performance status using the Karnofsky Performance Status (KPS) score. Secondary objectives were Eastern Cooperative Oncology Group (ECOG) status, quality of life, symptom severity, sarcopenia, spirometry (pulmonary function test and diffusing capacity of the lung for carbon monoxide), 6-minute walk distance, and eligibility for LT waitlisting. This is a prospective, single-arm, interventional study on patients with end-stage lung disease, meeting referral criteria for LT. A protocolized 12-week hybrid hospital and home-based virtual PR intervention was conducted, and all outcomes were assessed at baseline and at completion of the intervention. A total of 75 patients were enrolled, and the intervention was completed by 51 patients (68%). A total of 35 patients met LT listing criteria, 27 being "unfit" for LT at baseline, 18 of whom completed the intervention. Significant improvement was seen in KPS, ECOG, St. George's Respiratory Questionnaire score, visual analogue scale score for cough and dyspnoea, and sarcopenia for all 51 patients. Of the 18 patients unfit for waitlisting, 12 became fit, and 7 were waitlisted for LT. Patients eligible for LT who do not have access to regular PR may benefit from a hybrid (virtual and hospital-based) PR program, with improvement in KPS, quality of life, sarcopenia, and eligibility for LT waitlisting.