Feasibility of Virtual Assessment of Physical Frailty in Solid Organ Transplant Recipients – A Single Centre, Observational Study

Authors

  • Manoela de Paula Ferreira Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
  • Noori Chowdhury Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
  • Lisa Wickerson Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada & Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
  • Heather Ross Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
  • Nazia Selzner Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
  • S. Joseph Kim Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada & Medicine, Nephrology, University Health Network, Toronto, Ontario, Canada
  • Lianne G. Singer Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada & Medicine, Respirology, University Health Network, Toronto, Ontario, Canada
  • Sunita Mathur Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada & School of Rehabilitation Therapy, Queen’s University, Kingston Ontario, Canada

DOI:

https://doi.org/10.5195/ijt.2022.6447

Keywords:

COVID-19, Frailty, Telehealth, Transplantation

Abstract

Objectives: To describe the feasibility of virtual assessments of physical frailty in solid organ transplant (SOT) recipients using a modified Fried Frailty Index (mFFI) and Short Physical Performance Battery (SPPB), and to describe the prevalence of frailty 12-months post-transplant using virtual assessment. Methods: Virtual assessments were performed using an e-questionnaire and a video-call for functional tests. Feasibility variables included: internet quality, video-call duration, presence of a companion, and adverse events. Results: 34 SOT recipients, median age 62 (46-67), 76% lung recipients, 47% female, were included. The video-call had a median duration of 12 minutes (10-15 min), without adverse events. A companion was present in 23 (68%) video-call assessments. Fifteen SOT recipients (44%) were classified as pre-frail by the mFFI, and none were frail. Three participants (8.8%) were classified as frail using the SPPB. Conclusion: Virtual frailty assessments can be used as an alternative to in-person assessments in SOT recipients.

  

References

Abellan van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., Cesari, M., Donini, L.M., Gillette-Guyonnet, S., Inzitari, M., Nourhashemi, F., Onder, G., Ritz, P., Salva, A., Visser, M., Vellas, M. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. Journal of Nutrition, Health, and Aging, 13(10), 881-889. https://doi:10.1007/s12603-009-0246-z

Ali-Hassan, H., Eloulabi, R., Keethakumar, A. (2020). Internet non-use among Canadian Indigenous older adults: Aboriginal Peoples Survey (APS). BMC Public Health, 20, 1554. https://doi.org/10.1186/s12889-020-09659-5.

Baldwin, M.R., Singer, J. P., Huang, D., Sell, J., Gonzalez, W. C., Pollack, L. R., Maurer, M. S., D'Ovidio, F. F., Bacchetta, M., Sonett, J. R., Arcasoy, S. M., Shah, L., Robbins, H., Hays, S. R., Kukreja, J., Greenland, J. R., Shah, R. J., Leard, L., Morrell, M., Gries, C., Katz, P. P., Christie, J. D., Diamond, J. M., Lederer, D. J. (2017). Refining low physical activity measurement improves frailty assessment in advanced lung disease and survivors of critical illness. Annals of the American Thoracic Society, 14(8), 1270-1279. https://doi: 10.1513/AnnalsATS.201612-1008OC

Berg, K., Wood-Dauphine, S. L., Williams, J. L. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(S2), S7-S11. PMID: 1468055.

Bernabeu-Mara, R., Medina-Mirapeix, F., Llamazares-Herran, E., Garcia-Guillamon, G., Gimenez-Gimenez, L. M., Sanchez-Nieto, J. M. (2015). The Short Physical Performance Battery is a discriminative tool for identifying patients with COPD at risk of disability. International Journal of Chronic Obstructive Pulmonary Disease, 10, 2619-2626. https://doi:10.2147/COPD.S94377.

Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.00.

Crawford, A., Serhal, E. (2020). Digital Health Equity and COVID-19: The innovation curve cannot reinforce the social gradient of health. Journal of Medical Internet Research, 22(6), e19361. https://doi:10.2196/19361

Dechman G, Aceron R, Beauchamp M, Bhutani M, Bourbeau J, Brooks D, Goldstein R, Goodridge D, Hernandez P, Janaudis-Ferreira T, Saey D, Marciniuk D, Olsen S, Penz E, Ryerson C, Wald J, Weatherald J, Stickland MK. Delivering pulmonary rehabilitation during the COVID-19 pandemic: A Canadian Thoracic Society Position Statement. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 2020, 232-235. https://doi.org/10.1080/24745332.2020.1828683

Denby, K., Nelson, G., Estrada, C. A. (2013). Bedside hand grip assessment with the sphygmomanometer. Journal of General Internal Medicine, 28(10), 1381. https://doi:10.1007/s11606-013-2426-0.

Duncan, P. W., Weiner, D. K., Chandler, J., Studenski, S. (1990). Functional reach: A new clinical measure of balance. Journal of Gerontology, 45(6), M192-197. https://doi:10.1093/geronj/45.6.m192.

Exterkate, L., Slegtenhorst, B. R., Kelm, M., Seyda, M., Schuitenmaker, J. M., Quante, M., Uehara, H., El Khal, A., Tullius, S. G. (2016). Frailty and transplantation. Transplantation, 100(4), 4, 727-733. https://doi:10.1097/TP.0000000000001003

Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M.A., Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. Journals of Gerontology Series, 56(3), 146-56. https://doi:10.1093/gerona/56.3.m146

Galea, M. D. (2019). Telemedicine in Rehabilitation. Physical Medicine and Rehabilitation Clinics, 30(2), 473-483. https://doi:10.1016/j.pmr.2018.12.002

Goodarzi, L., Jones, Z., Posno, A., Straus, R., Waltt, S. E., Watt, J. A. (2021). Factors associated with virtual care access in older adults: A cross-sectional study. Age and Ageing, 50(4), 1412–1415. https://doi.org/10.1093/ageing/afab021

Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., Scherr, P. A., Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology; 49(2), M85-94. https://doi: 10.1093/geronj/49.2.m85

Hamilton, G. F., McDonald, C., & Chenier, T. C. (1992). Measurement of grip strength: Validity and reliability of the sphygmomanometer and Jamar grip dynamometer. Journal of Orthopaedic and Sports Physical Therapy, 16(5), 215–219. https://doi.org/10.2519/jospt.1992.16.5.215

Harhay, M. N., Rao, M. K., Woodside, K. J., Johansen, K. L., Lentine, K. L., Tullius, S. G., Parsons, R. F., Alhamad, T., Berger, J., Cheng, X. S., Lappin, J., Lynch, R., Parajuli, S., Tan, J.C., Segev, D. L., Kaplan, B., Kobashigawa, J., Dadhania, D. M., McAdams-DeMarco, M. A. (2020). An overview of frailty in kidney transplantation: measurement, management, and future considerations. Nephrology Dialysis Transplantation, 35(7), 1099-1112. https://doi:10.1093/ndt/gfaa016m

Hltaky, M. A., Boineau, R. E., Hlatky, M. A., Boineau, R. E., Higginbotham, M. B., Lee, K. L., Mark, D. B., Califf, R. M., Cobb, F. R., Pryor, D. B. (1989). A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index). American Journal of Cardiology, 64(10), 651-654. https://doi:10.1016/0002-9149(89)90496-7

Jha, S. R., Hannu, M. K., Newton, P. J., Wilhelm, K., Hayward, C. S., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Connellan, M., Jansz, P., Spratt, P. M., Montgomery, E., Smith, A., Harkess, M., Tunicliff, P., Davidson, P. M., Macdonald, P. S. (2017). Reversibility of frailty after bridge-to-transplant ventricular assist device implantation or heart transplantation. Transplant Direct, 3(7), e167. https://doi:10.1097/TXD.0000000000000690

Ji-Su Kim, R. N., Doeun, Y., RN, Hyun, J. K., Ho-Youl, R., Jaewon Oh, Seok-Min K. (2018). Need assessment for smartphone-based cardiac telerehabilitation. Healthcare Informatics Research, 24(4), 283-291. https://doi.org/10.4258/hir.2018.24.4.283.

Keating, S. E., Barnett, A., Croci, I., Hannigan, A., Elvin-Walsh, L., Coombes, J. S., Campbell, K. L., Macdonald, G. A., & Hickman, I. J. (2020). Agreement and reliability of clinician-in-clinic versus patient-at-home clinical and functional assessments: Implications for telehealth services. Archives of Rehabilitation Research and Clinical Translation, 2(3), 100066. https://doi.org/10.1016/j.arrct.2020.100066.

Kobashigawa, J., Dadhania, D., Bhorade, S., Adey, D., Berger, J., Bhat, G., Budev, M., Duarte-Rojo, A., Dunn, M., Hall, S., Harhay, M. N., Johansen, K. L., Joseph, S., Kennedy, C. C., Kransdorf, E., Lentine, K. L., Lynch, R. J., McAdams-DeMarco, M., Nagai, S., Olymbios, M., Patel, J., Pinney, S., Schauman, J., Segev, D. L., Shah, P., Singer, L. G., Singer, J. P., Sonnenday, C., Tandon, P., Tapper, E., Tullius, S. G., Wilson, M., Zamora, M., Lai, J. C. (2019). Report from the American Society of Transplantation on Frailty in Solid Organ Transplantation. American Journal of Transplantation, 19(4), 984-994. https://doi:10.1111/ajt.15198

Lai, J. C., Segev, D. L., McCulloch, C. E., Covinsky, K. E., Dodge, J. L., Feng, S. (2018). Physical frailty after liver transplantation. American Journal of Transplantation, 18(8), 1986-1994. https://doi:10.1111/ajt.14675

MacDonald, P. (2021). Frailty of the Heart Recipient. Transplantation, 105(11), 2352-2361. https://doi:10.1097/TP.0000000000003692

Montgomery, E., Macdonald, P. S., Newton, P. J., Chang, S., Wilhelm, K., Jha, S. R., Malouf, M. (2020). Reversibility of frailty after lung transplantation. Journal of Transplantation, 2020, 3239495. https://doi:10.1155/2020/3239495

Park, C., Sharafkhaneh, A., Bryant, M. S., Nguyen, C., Torres, I., Najafi, B. (2021). Toward remote assessment of physical frailty using sensor-based Sit-to-stand Test. Journal of Surgical Research, 263, 130-139. https://doi:10.1016/j.jss.2021.01.023

Portnoy, J., Waller, M., & Elliott, T. (2020). Telemedicine in the Era of COVID-19. Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1489–1491. https://doi.org/10.1016/j.jaip.2020.03.008

Rozenberg, D., Mathur, S., Wickerson, L., Chowdhury, N. A., Singer, L. G. (2018). Frailty and clinical benefits with lung transplantation. The Journal of Heart Lung Transplantation, 37(10), 1245-1253. https://doi:10.1016/j.healun.2018.06.005.

Schaenman, J., Goldwater, D., Malinis, M. (2019). An interdisciplinary approach to the older transplant patient: strategies for improving clinical outcomes. Current Opinion in Organ Transplantation, 24(4), 504-510. https://doi:10.1097/MOT.0000000000000662.

Simard, J., Chalifoux, M., Fortin, V., Archambault, M. J., St-Cerny-Gosselin, A., Desrosiers, J. (2012). Could questions on activities of daily living estimate grip strength of older adults living independently in the community? Journal of Aging Research, 2012, 427109. https://doi.org/10.1155/2012/427109

Singer, J. P., Soong, A., Bruun, A., Bracha, A., Chin, G., Hays, S. R., Kukreja, J., Rigler, J., Golden, J. A., Greenland, J. R., & Garvey, C. (2018). A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study. Clinical Transplantation, 32(6), e13274. https://doi.org/10.1111/ctr.13274

Singh, V, (2001). Rural and Small Town Canada Analysis Bulletin Catalogue. (Ray D. Bollman). Statistics Canada. ISSN 1481-0964. https://publications.gc.ca/Collection/Statcan/21-006-X/21-006-XIE2005008.pdf

Varughese, R.A., Theou O., Li, Y., Huang, X., Chowdhury, N., Famure, O., Selzner, N., MacIver, J., Mathur, S., Kim, S. J., Rockwood, K., Singer, L. G. (2021). Cumulative Deficits Frailty Index predicts outcomes for solid organ transplant candidates. Transplantation Direct, 7(3), e677. https://doi:10.1097/TXD.0000000000001094

Varughese, R., Rozenberg, D., Singer, L. G. (2020). An update on frailty in lung transplantation. Current Opinion in Organ Transplantation, 25(3), 274-279. https://doi:10.1097/MOT.0000000000000762

Watford, D. J., Cheng, X. S., Han, J., Stedman, M. R., Chertow, G. M., Tan, J. C. (2021). Toward telemedicine-compatible physical functioning assessments in kidney transplant candidates. Clinical Transplantation, 35(2), e14173. https://doi:10.1111/ctr.14173

Wickerson, L., Rozenberg, D., Gottesman, C., Helm, D., Mathur, S., Singer, L. G. (2020). Pre‐transplant short physical performance battery: Response to pre‐habilitation and relationship to pre-and early post–lung‐transplant outcomes. Clinical Transplantation, 34(12), e14095. https://doi:10.1111/ctr.14095

Zahiri, M., Wang, C., Gardea, M., Nguyen, H., Shahbazi, M., Sharafkhaneh, A., Ruiz, I. T., Nguyen, C. K., Bryant, M. S., Najafi, B. (2020). Remote physical frailty monitoring-the application of deep learning-based image processing in tele-health. IEEE Access, 8, 219391-219399. https://doi: 10.1109/access.2020.3042451

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Published

2022-05-25

How to Cite

Ferreira, M. de P., Chowdhury, N., Wickerson , L. ., Ross, H. ., Selzner , N. ., Kim , S. . J. ., Singer , L. G., & Mathur, S. . (2022). Feasibility of Virtual Assessment of Physical Frailty in Solid Organ Transplant Recipients – A Single Centre, Observational Study. International Journal of Telerehabilitation, 14(1). https://doi.org/10.5195/ijt.2022.6447

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Section

Virtual Frailty Assessments

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