A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study

Abstract

Background: Frailty is prevalent in lung transplant candidates (LTC) and is associated with waitlist delisting or death. We performed a pilot study to assess the safety and feasibility of a home-based, mobile health technology-facilitated intervention to treat frailty in LTC.

Methods: We performed an 8-week, nonrandomized, home-based exercise and nutrition intervention in LTC with Short Physical Performance Battery (SPPB) frailty scores of ≤11. The intervention utilized a customized, mobile device application ("app") enabling monitoring and progression of the intervention in real time. We aimed to evaluate key process measures. Secondarily, we tested whether the intervention could improve frailty scores quantified by the SPPB and Fried Frailty Phenotype (FFP).

Results: A total of 15 subjects enrolled were 63 ± 5.7 years old; oxygen requirements ranged from 3 to 15LPM. Thirteen subjects completed the intervention. Over 108 subject-weeks, there were no adverse events. Subjects found the app engaging and easy to work with. SPPB frailty improved in 7 (54%) and FFP improved in 8 (62%). There was a strong trend toward improved frailty scores (SPPB change 1.0 ± 1.9; P = .08; FFP change -0.6 ± 1.0; P = .07).

Conclusion: In this pilot study, we found that a home-based prehabilitation program that leverages mobile health technology to target frailty in LTC is well received, safe, and capable of improving physical frailty scores.

Keywords: exercise; frailty; lung transplant candidates; pilot study; rehabilitation.

Figure 1

Figure 1A. Patient-facing interface for mobile health frailty intervention platform. When a subject opens the Aidcube^™ app, he or she is presented first with his/her exercise prescription for the day. S/he inputs the number of repetitions performed for a particular exercise and then selects the “Next” button to automatically load the next exercise. Incorporating “gamification” for motivation, a white unsmiling cartoon face is located at the top of left of the screen. As activities are completed, the face the moves to the right and transitions from white to yellow to green and smiles. If the patient needs to, s/he can view a description and video of the exercise by clicking on the magnifying glass to the right of each exercise name. Figure 1B. Provider-facing interface for mobile health frailty intervention platform. Based on documented progress and responses to the weekly checkins with the study coordinator, the provider can advance the exercise prescription in the provider portal by adding time for aerobic activities, repetitions and/or sets for strength exercises, or adding new exercises. Exercises can also be re-ordered or replaced using simple commands to the right of each exercise name.

Figure 1

Figure 1A. Patient-facing interface for mobile health frailty intervention platform. When a subject opens the Aidcube^™ app, he or she is presented first with his/her exercise prescription for the day. S/he inputs the number of repetitions performed for a particular exercise and then selects the “Next” button to automatically load the next exercise. Incorporating “gamification” for motivation, a white unsmiling cartoon face is located at the top of left of the screen. As activities are completed, the face the moves to the right and transitions from white to yellow to green and smiles. If the patient needs to, s/he can view a description and video of the exercise by clicking on the magnifying glass to the right of each exercise name. Figure 1B. Provider-facing interface for mobile health frailty intervention platform. Based on documented progress and responses to the weekly checkins with the study coordinator, the provider can advance the exercise prescription in the provider portal by adding time for aerobic activities, repetitions and/or sets for strength exercises, or adding new exercises. Exercises can also be re-ordered or replaced using simple commands to the right of each exercise name.

Figure 2

Consort Diagram, Inclusion and Exclusion Criteria