Telehealth-delivered, Cardioprotective Diet and Exercise Program for Liver Transplant Recipients: A Randomized Feasibility Study

Abstract

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.

FIGURE 1.

Study Schema: Face-to-face screening and assessments performed by health practitioners before randomization into either MedDiet+E (intervention) or CON-DI. Baseline telehealth monitored outcomes were then collected from both groups before 12-wk RCT phase, in which MedDiet+E received the telehealth delivered program and CON-DI received usual care. Both groups repeated telehealth monitored outcome measures at wk 12. CON-DI then went on to receive the telehealth intervention for 12 wk followed by another repeat telehealth monitored outcome assessment on completion. CON-DI, delayed intervention control; MedDiet+E, Mediterranean diet + exercise Intervention group; RCT, randomized controlled trial.

FIGURE 2.

Consort diagram. CON-DI, delayed intervention control; MedDiet+E, Mediterranean-style diet + exercise intervention group.

FIGURE 3.

Mediterranean Diet Adherence Screener (MEDAS) scores (out of possible 14) preintervention and postintervention (n = 35) **P < 0.001, Wilcoxon signed rank test.

FIGURE 4.

Proportion of participants meeting the criteria for individual Mediterranean Diet Adherence Screener components (n = 35) *P < 0.05; **P < 0.01. To achieve a score for each question, participants were required to (1) use olive oil as the main source of fat for cooking, (2) include ≥4 tablespoons of olive oil a d, (3) include ≥2 servings of vegetables a d, (4) include ≥3 pieces of fruit per d, (5) include <1 serve of red meat or sausages per d, (6) include <1 serve butter/cream per d, (7) include <100 mL of sugar-sweetened beverages per d, (8) include ≥3 serves of legumes/pulses per wk, (9) include ≥3 serves of fish or shellfish per wk, (10) include <3 commercial sweets/pastries per wk, (11) include ≥3 serves of nuts a wk, (12) preferentially consume chicken, turkey, or rabbit instead of veal, pork, hamburger, or sausage, and (13) prepare ≥2 or more meals per wk seasoned with sofrito (sauce of tomatoes and onion, garlic, or leek, sautéed in olive oil).