Telehealth interventions to improve outcomes in lung transplant recipients: Primary results of the INSPIRE-III randomized clinical trial

Abstract

Background

There is growing evidence that many patients undergoing lung transplantation report significant distress and low physical activity (PA), which might not improve despite lung transplantation and may be associated with worse clinical outcomes. Few studies have attempted to improve psychological outcomes and functional capacity and PA after transplant.

Methods

Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III is a single-site, randomized clinical trial in which 180 post lung transplant patients, recruited between November 2019 and October 2023, completed a psychometric test battery to assess distress and functional capacity measured by the 6-Minute Walk Test and PA assessed by 7 consecutive days of continuous activity monitoring. Participants were then randomly assigned to either a 12-week Coping Skills Training and Exercise intervention (CSTEX) or a Standard of Care plus Education (SoC-ED) program delivered via telephone. Participants were then retested after completion of the telehealth interventions.

Results

After 12 weeks, both intervention groups achieved small but similar improvements in distress and functional capacity. Although there were no between-group differences overall, patients who were considered clinically depressed at baseline and received CSTEX achieved greater improvements in depression compared to depressed patients who received SoC-ED.

Conclusions

Although patients in both CSTEX and SoC-ED showed only modest benefit from their respective interventions, a subgroup of patients in CSTEX who were depressed at study entry had greater reductions in depressive symptoms compared to SoC-ED. Depressive symptoms should be carefully monitored post-transplant and referred for treatment if symptoms persist.

Trial registry

NCT04093869.