Dados do Resumo

Título

Implementation of a resistance exercise program in hematopoietic stem cell transplantation: adherence and impact on the clinical evolution of hospitalized patients

Introdução

Hematopoietic cell transplantation (HCT) causes physical disability and functional loss, which can be partially prevented and treated with resistance, aerobic, and endurance exercises. More recent studies suggest that less restrictive and more intense
rehabilitation programs are safe and effective in this population. Therefore, we updated the rehabilitation protocol for HCT at this institution in early 2021. However, we do not know the impact of these measures on our patients

Objetivo

To determine the impact of this new protocol on adherence to physical therapy, as well as other outcomes in clinical evolution.

Métodos

Case-control study, comparing patients admitted before the protocol update (standard protocol) with patients admitted after the protocol update (resistance protocol). The main outcome is to verify adherence to physical therapy. Secondary outcomes related to adherence to resistance exercise, length of hospital stay, and in-hospital complications.
This work was approved by the Ethics and Research Committee (3039/21), the participants of the study signed the free and informed consent form (ICF) or in its absence or impossibility of using the ICF, the ICF exemption form was used.

Resultados

A total of 101 (20%) patients participated in the study for the resistive protocol (RP) group from February 2021 to July 2023 and 409 (80%) patients in the standard protocol (PP) group who underwent HCT between January 2016 and December 2020. The median age among patients in both groups was 56 (18-78) years and males had a higher prevalence in both PP, 243 (59%) and PR, 55 (59%). Regarding clinical and demographic characteristics, there was similarity in both protocols, except for a higher proportion of other comorbidities in the PR protocol, 44 (44%) and a higher number of myeloablative conditioning in the PP protocol, 357 (87%). Most patients underwent physical therapy assistance, 397 (97%) in PP and 100 (99%) in PR. There was no lower adherence to RP compared to PP, p=0.36. There was no difference regarding total hospitalization time, ICU hospitalization time, ICU admission, orotracheal intubation (OIT) and total infection, in those who underwent PP compared to RP. Regarding risk factors for death, the diagnosis of Acute Leukemia, Allogeneic Transplantation,
Myeloablative conditioning, obesity, use of Noninvasive Mechanical Ventilation (NIMV), grafting time greater than 17 days and infections increased the risk of the patient evolving to death. On the other hand, patients with Monoclonal Gammopathies and those undergoing RP had a lower risk of death.

Conclusões

Performing a RP in patients undergoing HCT can be implemented safely, without decreasing adherence and without impacting length of hospital stay, ICU admission and OTI.

Financiador do resumo

Não houve fonte de financiamento

Palavras Chave

1 Rehabilitation; 2 Bone marrow transplant; 3 Exercises