Pulmonary Rehabilitation Referral Practice Patterns Across Lung Transplantation Centers in the United States: A Multi-Center Survey-Based Study

Abstract

Background: Functional status and frailty are important considerations in lung transplantation (LT) candidacy because of the potential impact on outcomes after LT. Once listed, waitlist duration can be unpredictable, and preservation of functional capacity is critical to prevent deterioration in conditioning. Pulmonary rehabilitation (PR) has been deemed to be a cornerstone of management of chronic lung disease; its role is often emphasized in lung transplantation.

Research question: What are the physician perceptions surrounding PR in LT centers in the United States?

Study design and methods: We used a web-based survey cross-sectional, multicenter survey to assess PR referral and utilization practices across different transplantation centers in the United States.

Results: Twenty-seven US LT centers (44 %) responded to the survey, with the majority respondents (76%) being medical directors. Most LT programs perceived a benefit of PR before transplantation being "likely or extremely likely" on waitlist death (66.7%), quality of life (pre-LT, 92.6%; post-LT, 88.9%), and ICU length of stay (88.9%). Lack of access to a nearby PR facility (88.9%), limited insurance coverage (76.9%), and limited number of life-time sessions (85.1%) were perceived as the most likely or very likely barriers to PR. In terms of post-LT rehabilitation, most patients were likely to receive daily physical therapy in the ICU (77%), inpatient PR (25%), and outpatient PR (61%). Virtual PR was the most preferred alternative (50%).

Interpretation: We found that PR is perceived to have a beneficial effect on pre-LT and post-LT outcomes by most LT programs. The most significant perceived barriers include patient access and payer coverage.

Keywords: frailty; lung transplantation; pulmonary rehabilitation; socioeconomic factor.