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Does Physical Therapy Matter among Heart Transplant Recipients While on Intra-Aortic Balloon Pumps in the Pretransplant Period?

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      Objectives

      Femoral insertion has a limitation regarding patient mobility thus prolonged bedrest and immobilization of the insertion site until transplantation. Prolonged femoral IABP support increases the risk for profound deconditioning, increases time to functional recovery and increases the risk of comorbidities. The objective was to assess the effectiveness of a tilting PT treatment protocol for patients who are awaiting heart transplantation as status 1A on IABP support via the femoral artery. The tilting protocol consists of supervised PT while the patient's bed is in a progressively increased angle using a VitalGo bed (VitalGo Systems Ltd., Fort Lauderdale, FL).
      We hypothesized that the benefits of this tilting program would promote weight-bearing for improved lower extremity strength and assist with acclimation to the upright position, thus decreasing the effects of orthostatic intolerance. The benefits should translate to a higher likelihood to be discharged to home as opposed to rehab and shorter length-of-stay [LOS] post-transplant.

      Methods

      We retrospectively reviewed charts from a single heart and vascular center over five years (January 2013-January 2018). Included patients were adults (>18) who were admitted with a cardiogenic shock or advanced heart failure diagnosis, placed on femoral IABP >15 days, had a transplant status of 1A, and received a PT consult. We compared outcomes (discharge location, LOS) from patients who participated in little to no (standard) physical therapy versus those who performed the tilting PT treatment protocol using a standard t-test. 12 patients met inclusion criteria. Six patients (4 men, 2 women, mean age 54.5 ± 13.9 years) received the tilting PT treatment protocol using VitalGo beds. Six patients (5 men, 1 women, mean age 47.1 ± 10.9 years) received standard physical therapy and served as the control group.

      Results

      In the tilting protocol group, 4 patients were discharged home and 2 were discharged to rehab. In the control group, 3 were discharged home and 3 were discharged to rehab. The average post-transplant LOS was significantly different; the tilting protocol group had an average LOS of 15.1± 9.26 days compared to an average of 29.8 ± 9.76 days in the control group (p=0.03).

      Conclusions

      While discharge result differences could not be established between the two groups, LOS post-transplant was significantly improved when the tilting PT program was implemented. Further, all supervised PT in patients (regardless of bed position) with femoral insertion of IABP did not result in access site complications, thrombosis or arrhythmias. Further study with a larger patient population is needed to confirm these findings and to investigate the impact of the tilting PT protocol on quality of life. Confirmation of this data would mean improved outcomes for patients along with decreased medical costs of recovery.