Prehabilitation Intervention to Maximize Early Recovery (PRIMER) in Liver Transplantation (PRIMER)
Liver Diseases, End Stage Liver Disease, Frailty
About this trial
This is an interventional treatment trial for Liver Diseases focused on measuring liver transplantation, malnutrition, exercise, prehabilitation, nutrition, sarcopenia
Eligibility Criteria
Inclusion Criteria:
- Participants must be wait-listed, in transplant evaluation, or "Penn Ready" with a MELD-Na score less than or equal to 25;
- Patients must be English speaking and own/use a smartphone and cognitively able to consent;
- Patient and physician feel that individual can safely participate in an exercise program;
- Meeting at least one 'at risk' criterion for impaired physical performance, frailty, or malnutrition (by SPPB, abPG-SG, dynamometer measured grip strength), or physical deconditioning as determined by physical therapist, or treating clinician.
Exclusion Criteria:
- The patient is unable to provide informed consent;
- The patient has been hospitalized within the last 30 days;
- A score of 0-3 points on the SPPB assessment indicating inability to participate in a physical activity program or a score of 12 in the absence of frailty or malnutrition (indicating low risk for poor physical or performance or malnutrition);
- The patient is at risk for falling as defined by clinician assessment results or if the patient states that he/she has a history of falling (record of a fall(s) in the past 30 days);
- The patient is already enrolled in a financial incentive-based exercise program using a wearable device;
- Any other medical conditions that would prohibit participation in a physical activity program as determined by transplant clinicians or severe vision, hearing, or mobility impairment precluding participation.
Sites / Locations
- Perelman Center for Advanced Medicine
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Arm 1 - Control Arm
Arm 2 - Intervention arm
Usual care, nutrition and exercise counseling at baseline, use of the Nokia GO wearable step tracker device and end-of-study assessment at the end of the 14-week study period. Participants will receive the Nokia GO wearable step tracker to monitor daily step counts, but they will not be provided with personalized walking goals or automated feedback on goal attainment via text message.
Physical activity program supported by financial incentives for meeting walking goals and participating in weekly check-in appointments with study team members via telephone calls. Participants in the intervention arm will also receive twice-daily medication reminders via bidirectional text messages to promote medication adherence. Participants in Arm 2 will also receive personalized nutrition and exercise counseling, daily feedback on step counts via the Nokia GO wearable step tracker and their smartphones, and an end-of-study assessment.