The Effectiveness of Telerehabilitation in Liver Transplant Patients

Investigation of the Effectiveness of the Telerehabilitation Program in Patients With Liver Transplantation

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"

Inclusion Criteria:

• Being between 18-65 years of age and having undergone a liver transplant
• Having had a liver transplant operation at least 6 months prior
• Spontaneous breathing
• Hemodynamic stability
• Reading and writing skills
• Ability to mobilize independently, ability to follow verbal and visual instructions

Exclusion Criteria:

• Presence of unstable cardiovascular disease
• Presence of primary lung disease requiring regular bronchodilator treatment
• Presence of neuromuscular disease or neurological complications
• Musculoskeletal limitation/use of assistive devices
• Being a multiple organ transplant recipient
• Presence of orthopedic disability and functional capacity limitation