Frailty Lecture

Frailty Assessment in the
Lung Transplant Population

• August 8th 2018
• 8 Maloney Conference Room
• Derek Zaleski PT, DPT
Objectives
• Review pre-transplant functional assessment
• Review physical therapy frailty assessment
• Understand the limitations of the frailty
assessment
• Understand frailty as a modifiable risk factor
• Understand impact of frailty on 30 day re-
admission and survival
Pre-transplant Rehabilitation Evaluation
• Same standards for an outpatient or an expedited inpatient evaluation
• 6MWT performed adhering to ATS standards.
– Patient utilizes resting level of supplemental O2 or
10 L/min if the resting supplemental oxygen is >10L/min.
– Patient ambulates until SpO2 decreases to less than 80%, and rests until SpO2 increases to
>85%.
• QOL questionnaire: EQ-5-DL
– Patient rates his or her perceived difficulty with:
• Ambulation
• Family Activities
• Self-care Activities
• Managing Pain and Discomfort
• Anxiety
• Global quality of life scale from 0 to 100.
Physical Therapy Examination
• History • Short performance
– Relevant body structure and
system impairments that
physical battery test
would affect post-transplant – 5x sit-to-stand test
rehabilitation and post- – Balance assessment
transplant outcomes.
• Communicate with referring team – 4.57 meter walk test
to address these issues prior to
listing OR establish a plan for
post-transplant management.
– IE: Lumbar or Thoracic Spine
Compression Fractures
Short Performance Physical Battery Test:
Five time sit-to-stand
5 times sit-to-stand
• Instructions to patient: “
• Please stand up straight as QUICKLY as you can five times, without stopping in between.
After standing up each time, sit down and then stand up again. Keep your arms folded
across your chest. I’ll be timing you with a stopwatch.”
Scoring
• Participant unable to complete 5 chair stands or completes stands in >60 sec: ❒0 points
• If chair stand time is 16.70 sec or more: ❒1 points
• If chair stand time is 13.70 to 16.69 sec or more: ❒2 points
• If chair stand time is 11.20 to 13.69 sec: ❒3 points
• If chair stand time is 11.19 sec or less: ❒4 points
Short performance physical battery test:
Balance
• Balance Assessment
– Side-by-side stance
– Semi-tandem stance
– Tandem stance
1. Side-by-side: I want you to try to stand with your feet together, side-by-side, for about 10
seconds.
2: Semi-tandem stance: I want you to try to stand with the side of the heel of one foot touching
the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is
more comfortable for you.
3. Tandem stance: Now I want you to try to stand with the heel of one foot in front of and
touching the toes of the other foot for about 10 seconds. You may put either foot in front,
whichever is more comfortable for you.
Balance Scoring
SCORING – SIDE-BY-SIDE STAND
1) Held for 10 sec: ☐ 1 point
2) Not held for 10 sec:☐ 0 points
3) Not attempted: ☐ 0 points (circle reason)
If 0 points, end Balance Tests Number of seconds held if less than 10 sec: sec
SCORING – Semi-Tandem STAND
1) Held for 10 sec: ☐ 1 point
2) Not held for 10 sec ☐ 0 points
If 0 points, end Balance Tests Number of seconds held if less than 10 sec: sec
SCORING –Tandem Stand
1) Held for 10 sec: ☐ 2 points
2) Held less than 10: ☐ 1 point - (3-9.99)
3) Held for < 3 sec: ☐ 0 points
Short Performance Physical Battery Test:
Gait Speed
• I am going to observe how you normally walk. If you use
a cane or other walking aid and you feel you need it to
walk a short distance, then you may use it.
• This is our walking course. I want you to walk to the

other end of the course at your usual speed, just as if you
were walking down the street to go to the store.
Re-admission Data
Penn Data-unplanned Initial Discharge Subsequent

readmissions (N=50) Discharges
Unplanned early 17 (34.0) 9 (26.5)
rehospitalizations
Preventable 4 (23.5) 2 (22.2)
Time to rehospitalization 10 16
Rehospitalization Length 5 (2-11) NR
Financial Impact of Readmissions
Characteristics of Rehospitalization w/in
30 Days of Initial Discharge (N=30)
Professional and hospital charges
for preventable rehospitalizations, $85,193 ($70,272-207,953)
median (IQR) ($)
Professional and hospital payments
for preventable rehospitalizations, $17,398 ($11,712-35,627)
median (IQR) ($)
Clinical Impact
Clinical Impact
• 60% of lung transplant recipients have a readmission within 30 days of a hospital
discharge
– 30% of readmissions after initial discharge
– 70% of readmissions are repeat admissions
• Frailty impacts survival, quality of life
– Develops in the hospital
• Customizable, patient specific rehabilitation plan as a novel, affordable mechanism
to mitigate the risk of readmission
– Improve survival
– Improve functional outcomes and quality of life
– Decrease healthcare expenditures
• Potential applicability to other post-surgical populations
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Frailty Assessment in the

Lung Transplant Population

• This is our walking course. I want you to walk to the

Penn Data-unplanned Initial Discharge Subsequent

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