A randomized, controlled, prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation.
A randomized, controlled, prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation.
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一种随机、受控的预康复干预措施，旨在最大限度地提高肝移植的早期恢复 (PRIMER)。
DOI：
10.1097/lvt.0000000000000198
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Reese,PeterP
中科院分区：
文献类型：
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作者：
Serper,Marina;Jones,LaurenS;Clement,Thomas;Reddy,RajenderK;Reese,PeterP
虚弱和功能状态受损与肝移植（LT）等候名单上和移植后的不良结果相关。 LT 之前的预康复很少经过测试。我们进行了一项 2 组患者随机试点试验，以评估 14 周行为干预在 LT 之前促进身体活动的可行性和有效性。 30 名患者按照 2:1 的比例随机分配至干预组 (n = 20) 与对照组 (n = 10)。干预部门获得了经济激励和与可穿戴健身追踪器相关的基于文本的提醒。每日步数目标每隔两周增加 15%。每周与研究人员进行检查，评估身体活动的障碍。主要结果是可行性和可接受性。次要结果包括研究结束时的平均步数、短期身体表现电池、握力和按相位角划分的身体成分。我们将次要结果的回归模型与手臂作为调整基线性能的暴露进行拟合。平均年龄为 61 岁，47% 为女性，终末期肝病钠模型 (MELD-Na) 的中位数为 13 岁。三分之一的人因肝脏衰弱指数而虚弱或处于脆弱状态，40% 的人因身体机能电池短而活动能力受损，近 40% 的人因生物阻抗相角患有肌少症，23% 的人有跌倒史，53% 的人患有糖尿病。研究保留率为 27/30（90%；2 例未纳入干预组，1 例在对照组中失访）。每周检查时自我报告坚持锻炼的比例约为 50%；最常见的障碍是疲劳、天气和肝脏相关症状。研究结束时，干预组的步数比对照组高出近 1000 步：调整后的差异 997，95% CI，147-1847； p=0.02。平均而言，干预组有 51% 的时间实现了每日步数目标。对于患有功能障碍和营养不良的 LT 候选者来说，采用经济激励和基于文本的推动的家庭干预是可行的、高度接受的，并且可以增加每日步数。
Frailty and impaired functional status are associated with adverse outcomes on the liver transplant (LT) waitlist and after transplantation. Prehabilitation prior to LT has rarely been tested. We conducted a 2-arm patient-randomized pilot trial to evaluate the feasibility and efficacy of a 14-week behavioral intervention to promote physical activity prior to LT. Thirty patients were randomized 2: 1 to intervention (n= 20) versus control (n= 10). The intervention arm received financial incentives and text-based reminders linked to wearable fitness trackers. Daily step goals were increased by 15% in 2-week intervals. Weekly check-ins with study staff assessed barriers to physical activity. The primary outcomes were feasibility and acceptability. Secondary outcomes included mean end-of-study step counts, short physical performance battery, grip strength, and body composition by phase angle. We fit regression models for secondary outcomes with the arm as the exposure adjusting for baseline performance. The mean age was 61, 47% were female, and the median Model for End-stage Liver Disease sodium (MELD-Na) was 13. One-third were frail or prefrail by the liver frailty index, 40% had impaired mobility by short physical performance battery, nearly 40% had sarcopenia by bioimpedance phase angle, 23% had prior falls, and 53% had diabetes. Study retention was 27/30 (90%; 2 unenrolled from intervention, 1 lost to follow-up in control arm). Self-reported adherence to exercise during weekly check-ins was about 50%; the most common barriers were fatigue, weather, and liver-related symptoms. End-of-study step counts were nearly 1000 steps higher for intervention versus control: adjusted difference 997, 95% CI, 147–1847; p= 0.02. On average, the intervention group achieved daily step targets 51% of the time. A home-based intervention with financial incentives and text-based nudges was feasible, highly accepted, and increased daily steps in LT candidates with functional impairment and malnutrition.