Is your transplant patient leading a sedentary lifestyle?
Thursday, October 20, 2016
Patients with advanced cirrhosis are at a high risk for frailty, which increases the risks of liver-related death, transplant wait-list attrition and major transplant complications. Regular activity helps patients with cirrhosis avoid frailty and its complications, but a new study shows patients waiting for liver transplants are highly sedentary.
The research also suggests patient self-assessment — and their doctors' assessments — do not reliably indicate patients' actual physical activity. There are currently about 17,000 patients on the waiting list for liver transplants, according to the American Liver Foundation, and about 1,500 die annually waiting for a liver to become available.
Researchers enrolled 53 wait-listed patients into the study. Among the participants, 75.9 percent of their time during waking hours was considered sedentary with 18.8 percent of the time deemed light activity. Subjects spent only 4.8 percent of their time awake engaged in moderate-to-vigorous activity.
In this study, patients who died while waiting for a transplant had a significantly higher percentage of sedentary behavior than those who survived.
The study subjects used the Rosow-Breslau survey to perform a self-assessment of their ordinary physical tasks. Participating clinicians used the Karnofsky index to assess patients' physical performance. The researchers fitted participants with accelerometer/thermal-sensing armbands, which the study subjects wore for four to seven days. The scientists then compared the self-assessments and clinician assessments with the data gathered with the armbands.
The scientists found the measured activity among the subjects included in this study was among the lowest reported in chronic disease, with activity levels similar to patients with renal failure or advanced chronic pulmonary disease.
Healthy adults take 7,000 to 13,000 steps each day. Patients on the wait list for transplantation should take 5,000 steps per day to avoid frailty and sarcopenia. The participants of this study took an average of only 3,164 steps daily.
Both the step data and activity percentage of subjects were typical of other severely inactive populations. Higher mean sedentary activity and lower mean moderate-to-vigorous activity was strongly associated with nine wait-list deaths.
Transplant teams subjectively assess physical performance in selecting patients for transplant listing, but clinicians do not always know whether their clinical assessments accurately reflect the extent of physical activity that the patients actually perform. The new study made this evident.
Neither the Rosow-Breslau scores nor the Karnofsky scores showed a correlation with the participants' actual physical activity, nor did they suggest a major impairment of performance.
"Patients' deficits in physical activity were often missed using standardized subjective clinical assessments," wrote Dr. Michael Dunn, lead author of the study.
The results of the study suggest patients with cirrhosis who are wait-listed for liver transplantation are highly sedentary, and that provider assessments and physical assessments are not reliable indicators of actual performance. Further study may shed light on whether intervention can modify the gap between assessed and actual performance to improve physical activity and ameliorate frailty associated with sarcopenia in patients with cirrhosis wait-listed for transplantation.
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