RESUMO
Rapid excess weight gain and metabolic complications contribute to poor outcomes following liver transplant care. Providing specialist lifestyle intervention with equitable access is a challenge for posttransplant service delivery. METHODS: This study investigated the feasibility of a 12-wk telehealth delivered lifestyle intervention for liver transplant recipients (randomized controlled trial with a delayed intervention control group). The intervention included 14 group sessions facilitated by nutrition and exercise specialists via video streaming telehealth and participants used their own devices. Feasibility was assessed across session attendance, the adequacy, acceptability, and confidence with the telehealth technology and adherence to diet (Mediterranean Diet Adherence Score). Secondary pooled analysis of effectiveness was determined from changes in quality of life and metabolic syndrome severity score. RESULTS: Of the 35 participants randomized, dropout was 22.8% (n = 8) and overall session attendance rate was 60%. Confidence with and adequacy of home technology was rated high in 96% and 91% of sessions, respectively. Participants randomized to the intervention significantly improved Mediterranean Diet Adherence Score (2-point increase [95% confidence interval, 1.5-3.4] versus control 0 point change [95% confidence interval, -1.4 to 1.2]; P = 0.004). Intervention (within group) analysis found the intervention significantly decreased the metabolic syndrome severity score (-0.4 [95% confidence interval, -0.6 to -0.1] P = 0.01), and improved mental health-related quality of life (2.5 [95% confidence interval, 0.4-4.6] P = 0.03). CONCLUSIONS: A cardioprotective lifestyle intervention delivered via telehealth is feasible for liver transplant recipients and may improve access to specialist care to support metabolic health and wellness after transplant.
RESUMO
OBJECTIVE: To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. DESIGN: Reliability study: repeated-measure, within-subject design. SETTING: Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. PARTICIPANTS: Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). RESULTS: The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [-2.2 to 3.6kg]; waist 0.4 (-1.2 to 2.0) cm [-5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [-19.4 to 34.9mmHg]; DBP 2.4 (-1.4 to 6.2 ) mmHg [-12.2 to 17.0mmHg]; 6MWT, 7.5 (-29.1 to 44.1) m [-127.3 to 142.4m]; STST 0.5 (-0.8 to 1.7) seconds [-4.3 to 5.3s]; maximal push-ups -2.2 (-4.4 to -0.1) [-10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement. CONCLUSIONS: Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.
