Comparison of Intensive Pulmonary Rehab Versus Traditional Pulmonary Rehab

Background: UPMC Presbyterian Pulmonary Rehab implemented a more intensive pulmonary rehab (IPR) protocol for post-lung transplant recipients with the aim of accelerating improvement of patients’ functional capacity, strength, and endurance to facilitate home discharge. A traditional pulmonary rehab (TPR) consists of 2-3 days per week for up to 12-18 weeks, whereas IPR consists of training 4-5 days per week for 3-5 weeks. We assessed the effectiveness of the IPR compared to TPR. Methods: After receiving IRB approval, we performed a comparison of retrospective data collected on all post-transplant recipients enrolled in the TPR program prior to the implementation of the IPR program with those measures in the IPR population. Criteria for the IPR group for discharge to their home maintenance program is observation of a plateau in the patients’ weekly physical assessments of grip strength, balance, frailty, and functional capacity. We compared proportion of patients in the two groups achieving: minimally important improvement in 6-minute walk functional capacity (98 feet), any improvement in Timed Up and Go (TUG), and any increase in maximal Metabolic Equivalency Threshold (MET) achieved during incremental testing on a recumbent cycle. We considered non-inferiority in outcome to be less than a 10% drop (or increase) in proportion of patients achieving the stated goal. Results: 46 patients were included in the IPR group and 88 patients in the TPR group. 98% of patients enrolled in IPR and 92% of patients enrolled in TPR met minimum clinically important differences for 6-minute walk functional capacity. TUG measurements improved in 93% of IPR and 92% of TPR patients. METS during incremental recumbent cycling improved in 89% of IPR population and 94% of TPR population. IPR patients were discharged after 14.5 ± 5.5 sessions over 4.1 ± 1.1 weeks in contrast to TPR goals of 36 sessions over 12-18 weeks. Conclusions: The post-lung transplant population is benefited by being enrolled in an intensive pulmonary rehab program as evidenced by non-inferior outcomes assessing functional status and frailty measures achievable in significantly fewer sessions over a shorter time period. Continuation or implementation of an IPR program for post-lung transplant recipients is justified by our findings.