A multimodal aftercare intervention improves the outcome after kidney transplantation - results of the KTx360° aftercare program using claims data.

Background: The after-care treatment project KTx360° aimed to reduce graft failure and mortality after kidney transplantation (KTx). Methods: The study was conducted in the study centers Hannover, Erlangen and Hannoversch Muenden from May 2017 to October 2020 under the trial registration ISRCTN29416382. The program provided a multimodal aftercare program including specialized case management, telemedicine support, psychological and exercise assessments, and interventions. For the analysis of graft failure, which was defined as death, re-transplantation or start of long-term dialysis, we used longitudinal claims data from participating statutory health insurances (SHI) which enabled us to compare participants with controls. To balance covariate distributions between these nonrandomized groups we used propensity score methodology, in particular the inverse probability of treatment weighting (IPTW) approach. Findings: In total, 930 adult participants were recruited at three different transplant centres in Germany, of whom 320 were incident (enrolled within the first year after KTx) and 610 prevalent (enrolled >1 year after KTx) patients. Due to differences in the availability of the claims data, the claims data of 411 participants and 418 controls could be used for the analyses. In the prevalent group we detected a significantly lower risk for graft failure in the study participants compared to the matched controls (HR = 0.13, 95% CI = 0.04-0.39, p = 0.005, n = 389 observations), whereas this difference could not be detected in the incident group (HR = 0.92, 95% CI = 0.54-1.56, p = 0.837, n = 440 observations). Interpretation: Our findings suggest that a multimodal and multidisciplinary aftercare intervention can significantly improve outcome after KTx, specifically in patients later after KTx. For evaluation of effects on these outcome parameters in patients enrolled within the first year after transplantation longer observation times are necessary. Funding: The study was funded by the Global Innovation fund of the Joint Federal Committee of the Federal Republic of Germany, grant number 01NVF16009.

[Comprehensive care for kidney transplantation-optimization of interdisciplinary support before and after kidney transplantation]. / Rundumversorgung Nierentransplantation ­ Optimierung der interdisziplinären Betreuung vor und nach Nierentransplantation.

Due to the divergence between the number of potential organ recipients and organ availability, transplant survival is of particular importance. In order to create the best possible conditions, it is not only important to address the risk factors for loss of organ functionality after transplantation, but also to focus on the time before transplantation. During this period, which lasts several years on average, the patient can create the conditions for risk reduction before and after transplantation with support. The optimization of physical health plays an important role here in order to maintain transplantability, on the one hand, and to counteract the general loss of physical performance due to dialysis, on the other. Therefore, the focus must be placed on "exercise" and "nutrition", which represent an increased risk of declining physical health in dialysis patients. After transplantation, the focus should again be on physical health. Through support, patients learn how to improve their cardiovascular risk profile and increase their physical performance. Psychosocial support is also important to combat psychological comorbidities and prevent risks such as nonadherence. In addition to improved physical and mental health, the focus here is also on the long-term survival of the patient and the transplant.

Adherence and potential factors of adherence to a resistance, coordination and endurance training in older retirement home residents over 6 months.

INTRODUCTION: High exercise adherence is a key factor for effective exercise programmes. However, little is known about predictors of exercise adherence to a multimodal machine-based training in older retirement home residents. AIMS: To assess exercise adherence and potential predictors of adherence. Furthermore, to evaluate user acceptance of the multimodal training and the change in exercise self-efficacy. METHODS: In this sub-analysis of the bestform-F study, a total of 77 retirement home residents ≥65 years (mean age: 85.6 ± 6.6 years, 77.9% female) participated in a 6-month machine-based resistance, coordination and endurance training. Attendance to the training was documented for each training session. To identify potential predictors a multiple linear regression model was fitted to the data. Analyzed predictors included age, sex, body mass index (BMI), physical function, exercise self-efficacy, and physical activity history. Different domains of user acceptance (e.g. safety aspects, infrastructure) and exercise self-efficacy were assessed by a questionnaire and the exercise self-efficacy scale (ESES), respectively. RESULTS: Mean exercise adherence was 67.2% (median: 74.4%). The regression model (R2 = 0.225, p = 0.033) revealed that the 6-minute walk test (6-MWT) at baseline significantly predicted exercise adherence (ß: 0.074, 95% confidence interval (CI): 0.006-0.142, p = 0.033). Different user domains were rated at least as good by 83.9%-96.9% of participants, reflecting high acceptance. No statistically significant change was found for exercise self-efficacy over 6 months (mean change: 0.47 ± 3.08 points, p = 0.156). CONCLUSION: Retirement home residents attended more than two thirds of offered training sessions and physical function at baseline was the key factor for predicting adherence. User acceptance of the training devices was highly rated. These findings indicate good potential for implementation of the exercise programme.

Bestform-F - Best Function of Range of Motion: A Feasibility Study of a Multimodal Exercise Training Program for Older Adults in Retirement Homes.

Purpose: Mobility is a crucial factor for independence and quality of life in old age. Nevertheless, many old people in retirement homes do not meet the physical activity recommendations. The aim of the Bestform-F - Best Function of Range of Motion feasibility study (bestform-F) was to evaluate the feasibility of implementing a machine-based multimodal exercise training program in older residents in retirement homes. Materials and Methods: The participants (n = 77) were recruited from two retirement homes and took part in a six-month multimodal exercise training program (2x/week, 45 minutes) on pneumatic strength training machines, a balance platform and bicycle ergometers. Feasibility criteria were recruitment number ≥ 35 participants within six months, dropout rate < 40% of participants within six months of exercise, and training adherence ≥ 50% of participants taking part in at least 50% of offered training sessions. Additionally, physical performance, fear of falling, cognitive function, and quality of life were assessed at baseline and after six months. Results: For the bestform-F study, 77 (85.6 ± 6.6 years; 78% women) out of 215 eligible residents from two senior residences were recruited. The dropout rate over six months was 10% (8/77 participants). The training adherence rate for the finishing participants was 77% (53/69 participants). In addition to the achieved feasibility criteria, significant improvements were recorded in the Chair Stand Test, Six-Minute Walk Test, and fear of falling after six months. Conclusion: All feasibility criteria have been fulfilled. The high number of recruited participants, the low dropout rate, and high adherence to the training program confirm the feasibility of a multimodal machine-based exercise training program offered to residents in retirement homes. The results provide a basis for a cluster-randomized controlled trial aimed at further investigating the efficacy of the bestform-F program.