Outcomes in randomized controlled trials of exercise interventions in solid organ transplant

AIM To identify the outcome measures that have been used in randomized controlled trials(RCTs) of exercise training in solid organ transplant(SOT) recipients and to link these outcomes to the International Classification of Functioning, Disability and Health(ICF) framework.METHODS Electronic literature searches of MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science were performed. We sought RCTs that investigated the effect of exercise training in SOT recipients. Reference lists of all eligible publications were searched for other appropriate studies not identified by the electronic search. A complete list of outcome measures used in the RCTs was generated and each of these was linked to an ICF category.RESULTS Four hundred and thirteen articles were retrieved, of which 35 met our inclusion criteria. The studies included were designed to compare the effects of exercise training programs to usual care or to another exercise training program and reported on recipients of heart(n = 21), kidney(n = 9), lung(n = 3) or liver(n = 2) transplant. Of the 126 outcome measures identified, 62 were used as primary outcome measures. The most commonly occurring primary outcomes were aerobic capacity using the peak VO2(n = 13), quality of life using the shortform-36(n = 8), and muscle strength(n = 7). Theseoutcome measures were linked to 113 ICF categories and the majority of outcomes fall into the body function domain(n = 93). CONCLUSION There is little standardization in outcome measures used in RCTs of exercise interventions in SOT recipients. The ICF framework can be used to select a core set of outcomes that cross all domains of ICF and that would be appropriate to all SOT recipients.

Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach

Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and posttransplant patient care and rehabilitation researchers.

AB095. Development of an assessment system of driver visual behaviours on a car simulator

Background:(I)To describe the development and components of the automobile simulator driving behavior evaluation system developed by CRIR-Institut Nazareth et Louis-Braille;(II)to present the preliminary results of the content evaluation of the driving behavior evaluation grid.Methods:The evaluation system consists of five components:(I)the VS500M Car Simulator(Virage Simulation);(II)four VS500M driving scenarios,modified to minimize the occurrence of simulator sickness and expose subjects to commonly encountered driving situations on highways and city boulevards;(III)the Tobii Pro Glasses 2 eye tracking device;(IV)a car simulator driving behavior observation grid(DBOG);(V)a software application used during the behaviour evaluation phase,where synchronized video tracking,certain data from the simulator(e.g.,speed)and the DBOG grid are presented.Initially,the expected safe driving behaviors were identified,including 235 of a visual nature,supported by literature data and consultation of the project steering committee and an expert in driving assessment.Driving behaviors were assessed in 22 subjects without visual impairment(mean age 55±20 years).Subsequently,the items were revised to determine their relevance based on their importance in terms of road safety or on the frequency with which behaviors were observed among participants.For analysis purpose,the items of the DBOG were grouped according to their content,by type of expected driving behavior(e.g.,following a stop,look to the left and right before crossing the intersection)or element to be detected(e.g.,pedestrians).Results:Some visual behaviors are difficult to observe with the eye tracker device because they are more dependent on peripheral than central vision.Others are rarely observed,possibly because they are little or not realized in daily life or the representation of reality on the simulator does not stimulate their adoption.On the other hand,the visual detection behaviors expected in a situation where safety can be compromised are mostly carried out(e.g.,detection of oncoming vehicles,side mirror verification when changing lanes).Conclusions:This first phase of the study has made possible to better target the items to be kept in the car simulator driving behavior observation grid,and those that will have to be removed as they are too difficult to observe or too rarely adopted by the participants.Content validity and inter-rater reliability will be assessed from the simplified grid.

AB029.Investigating the link between reduced reading ability and cognitive decline in older adults with acquired vision impairment:a feasibility study

Background:Reading enables us to obtain information,to engage in leisure,educational,business and other activities,and fosters cognitive stimulation.Acquired vision loss can have a negative effect on an individual’s ability to read,and,by extension,reduce overall quality of life.In addition,a growing body of research on the association between reading and cognition has linked a decrease in reading ability with negative changes in cognitive function.Therefore,the purpose of the current study is to test the feasibility of a research protocol that will be used to study the association between reduced reading ability and cognitive impairment,specifically in older adults with acquired vision loss.Methods:Seven participants(age range,27-60 years,Mage=44,4 males)completed a series of questionnaires and assessments that measured their cognitive,hearing,and reading abilities.All participants had normal hearing,vision and cognition,with the exception of one(two pre-existing hearing conditions).Cognition was tested using the Rey Auditory Verbal Learning Test(RAVLT),the RAVLT 50-word Recognition test,the Verbal Fluency Test,an auditory Trail-Making task,and an auditory 1-N-back memory task.Otoscopy was used to assess ear health,and hearing was measured with self-administered computerized audiometry(Home Hearing Test)and a speech-in-noise test(Canadian Digit Triplet Test).Questionnaires included the Hearing Handicap Inventory for the Elderly,and a multiple-choice questionnaire on subjective reading ability and reading habits.Finally,reading acuity,speed and comprehension were assessed using the International Reading Speed Texts and the MNRead.Results:In testing the feasibility of this protocol,the uninterrupted length of testing time,including obtaining consent,was determined to be between 60-90 min.Several of the assessments and tests(RAVLT,MNRead,audiogram)were reported to be mentally taxing.However,all pilot participants were able to complete all tasks.With the exception of standardized tests,some of the instructions required refinement and clarification,in order to better explain the tasks for each test.Conclusions:Anticipating that the protocol will be more demanding for the ultimate target population,who will be older adults with sensory impairment,these pilot results were used to guide a strategy for collecting the dependent measures.It was decided to administer the most important measure in each of the domains(e.g.,MNRead,audiogram,RAVLT)to ensure that data on vision,hearing,reading and cognition are collected.Depending on the level of fatigue and motivation of the participants,secondary measures in each domain(the International Reading Speed Texts,CDTT,the 1-N-back task)will be administered afterward.Multiple sessions and breaks will be offered as needed.Data collection with novice vision rehabilitation clients will begin at the end of January 2019.