Liver transplantation is defined as a surgical procedure in which a liver with tissue damage and inability to perform its functions is replaced, in whole or in part, with a healthy liver obtained from a living or deceased donor. Post-transplantation treatment includes medical treatment, physiotherapy, and rehabilitation. Physiotherapy and rehabilitation, an important component of liver transplantation management, consists of three phases: preoperative, early postoperative, and late postoperative. Telerehabilitation is currently defined as the control or monitoring of rehabilitation remotely using telecommunication-related technologies. Studies on telerehabilitation in liver transplant patients are insufficient in the literature. The aim of this study is to investigate the effect of a telerehabilitation-based exercise program applied to liver transplant patients on exercise capacity, respiratory muscle strength, peripheral muscle strength, fatigue level and quality of life.
Participants will be randomly divided into two groups: a telerehabilitation group and home exercise program group. Both groups will be evaluated before and after treatment (week 8). The telerehabilitation group will receive videoconference-based telerehabilitation three days a week for eight weeks. All exercises will be performed under the supervision of a physiotherapist. Each telerehabilitation session will last approximately 30-45 minutes. The exercises will be performed in the following order: breathing exercises, strengthening exercises, balance exercises, and walking exercises. The home exercise program group will receive an exercise brochure after the initial evaluation. Both groups will continue with their standard medical treatments, and a second evaluation will be conducted at the end of eight weeks. Participants' exercise capacity will be assessed using the "6-Minute Walk Test," fatigue level using "The Fatigue Severity Scale", respiratory muscle strength by measuring "Maximal inspiratory pressure (MIP)" and "Maximal expiratory pressure (MEP)", muscle strength using a digital dynamometer, balance using the "Timed Up and Go Test," and quality of life using the "The Liver Disease Symptom Index 2.0"
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
58
The telerehabilitation program will include breathing, strengthening, balance, and walking exercises, with increasing intensity week by week, and stretching exercises targeting major muscles will be given during the cool-down period.
Patients will be given brochures on breathing, strengthening, balance and walking exercises and asked to perform them without a physiotherapist.
Istanbul University-Cerrahpasa, Faculty of Health Sciences, Physiotherapy and Rehabilitation Laboratory
Büyükçekmece, Istanbul, Turkey (Türkiye)
6-Minute Walk Test
Exercise capacity will be assessed using the Six-Minute Walk Test, which plays an important role in evaluating pre- and post-operative exercise performance in liver transplant patients. The test will be conducted in a 30 m long, enclosed, straight corridor under the supervision of a physiotherapist, in accordance with the criteria set by the American Thoracic Society. The patients' heart rate and peripheral capillary oxygen saturation values will be recorded before, during, and after the test using a portable pulse oximeter. Dyspnea and perceived fatigue levels will be assessed using the Modified Borg Scale (MBS) during the test. The total walking distance completed in six minutes will be recorded in meters as the individual's six-minute walk distance
Time frame: eight weeks
Timed Up and Go Test
Used to evaluate the balance performance of individuals during movement. The person sits in a chair of standard height (46 cm), a distance of 3 meters is measured from the chair and a cone is placed at the end of this distance to indicate it. After receiving the command "walk as fast as you can and sit back down in the chair," the person gets up, walks down the corridor for meters, turns around, walks back to the chair and sits down. The time from the moment of getting up from the chair until the person turns around and sits back down in the chair is measured with a stopwatch and recorded in seconds.
Time frame: eight weeks
The Liver Disease Symptom Index 2.0
The Chronic Liver Disease Quality of Life Scale 2.0 will be used as a disease-specific measurement tool. It is a scale developed to objectively evaluate the clinical and psychological consequences on physical and daily living activities in chronic liver disease and to determine the severity of the disease. The Chronic Liver Disease Quality of Life Scale 2.0 , which has been applied in different stages of chronic liver diseases and psychometrically tested, evaluates the effects of symptoms on daily life as well as symptom severity. It is a useful and practical scale in clinical use, whose validity and reliability have been established in the Turkish population
Time frame: eight weeks
The Fatigue Severity Scale
The Fatigue Severity Scale (FSS) is a nine-item self-administered scale. The scale correlates moderately well with the Visual Analog Scale (VAS) and is therefore a good tool for assessing the severity of fatigue. Patients are asked to choose a number from 1 to 7 indicating how much they agree or disagree with the statement. "1 point" indicates strong disagreement, "7 points" indicates strong agreement. A score of 4 and above generally indicates severe fatigue.
Time frame: eight weeks
Respiratory Muscle Strength Measurement
Respiratory muscle strength will be assessed by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which are intraoral pressure measurements. The measurement will be performed using a portable intraoral pressure gauge with the maximal breathing method while the airway is closed with a valve.
Time frame: eight weeks
Muscle Strength Measurement
This is a method used to measure muscle strength in patients. A La Fayette handheld digital dynamometer will be used during the test. To obtain isometric contraction during the test, the person performing the measurement is asked to hold the dynamometer steady while the person being tested applies maximum contraction against the device. The patient will be asked to hold the maximal isometric contraction for 5 seconds, followed by a 30-second rest interval and the same procedure will be repeated 3 times on the dominant side and the average of the measurement values will be recorded.
Time frame: eight weeks
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