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.

Study Overview

• Status: Not yet recruiting
• Conditions: Liver Transplantation; Telerehabilitation
• Intervention / Treatment: Other: Telerehabilitation; Other: Home exercise

Detailed Description

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"

• Study Type: Interventional
• Enrollment (Estimated): 58
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Alper AYAS, MSc; Phone Number: +90 505 952 63 15; Email: alper.ayas@ogr.iuc.edu.tr

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Büyükçekmece, Istanbul, Turkey (Türkiye), 34500
      • Istanbul University-Cerrahpasa, Faculty of Health Sciences, Physiotherapy and Rehabilitation Laboratory
      • Contact: Rüstem Mustafaoğlu, associate professor; Phone Number: +90 555 417 85 35; Email: rustem.mustafaoglu@iuc.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Home exercise program group; Home exercise program group will initially be given instructions on the exercises and asked to perform them three days a week for eight weeks. They will be contacted by phone once a week to inquire whether they are doing the exercises.	Other: Home exercise; Patients will be given brochures on breathing, strengthening, balance and walking exercises and asked to perform them without a physiotherapist.
Experimental: Telerehabilitation group; 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.	Other: Telerehabilitation; The telerehabilitation program will include breathing, strengthening, balance, and walking exercises, with increasing intensity week by week, and stretching exercises targeting major muscles will be given during the cool-down period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
6-Minute Walk Test	Exercise capacity will be assessed using the Six-Minute Walk Test, which plays an important role in evaluating pre- and post-operative exercise performance in liver transplant patients. The test will be conducted in a 30 m long, enclosed, straight corridor under the supervision of a physiotherapist, in accordance with the criteria set by the American Thoracic Society. The patients' heart rate and peripheral capillary oxygen saturation values will be recorded before, during, and after the test using a portable pulse oximeter. Dyspnea and perceived fatigue levels will be assessed using the Modified Borg Scale (MBS) during the test. The total walking distance completed in six minutes will be recorded in meters as the individual's six-minute walk distance	eight weeks
Timed Up and Go Test	Used to evaluate the balance performance of individuals during movement. The person sits in a chair of standard height (46 cm), a distance of 3 meters is measured from the chair and a cone is placed at the end of this distance to indicate it. After receiving the command "walk as fast as you can and sit back down in the chair," the person gets up, walks down the corridor for meters, turns around, walks back to the chair and sits down. The time from the moment of getting up from the chair until the person turns around and sits back down in the chair is measured with a stopwatch and recorded in seconds.	eight weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Liver Disease Symptom Index 2.0	The Chronic Liver Disease Quality of Life Scale 2.0 will be used as a disease-specific measurement tool. It is a scale developed to objectively evaluate the clinical and psychological consequences on physical and daily living activities in chronic liver disease and to determine the severity of the disease. The Chronic Liver Disease Quality of Life Scale 2.0 , which has been applied in different stages of chronic liver diseases and psychometrically tested, evaluates the effects of symptoms on daily life as well as symptom severity. It is a useful and practical scale in clinical use, whose validity and reliability have been established in the Turkish population	eight weeks
The Fatigue Severity Scale	The Fatigue Severity Scale (FSS) is a nine-item self-administered scale. The scale correlates moderately well with the Visual Analog Scale (VAS) and is therefore a good tool for assessing the severity of fatigue. Patients are asked to choose a number from 1 to 7 indicating how much they agree or disagree with the statement. "1 point" indicates strong disagreement, "7 points" indicates strong agreement. A score of 4 and above generally indicates severe fatigue.	eight weeks
Respiratory Muscle Strength Measurement	Respiratory muscle strength will be assessed by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which are intraoral pressure measurements. The measurement will be performed using a portable intraoral pressure gauge with the maximal breathing method while the airway is closed with a valve.	eight weeks
Muscle Strength Measurement	This is a method used to measure muscle strength in patients. A La Fayette handheld digital dynamometer will be used during the test. To obtain isometric contraction during the test, the person performing the measurement is asked to hold the dynamometer steady while the person being tested applies maximum contraction against the device. The patient will be asked to hold the maximal isometric contraction for 5 seconds, followed by a 30-second rest interval and the same procedure will be repeated 3 times on the dominant side and the average of the measurement values will be recorded.	eight weeks

Collaborators and Investigators

• Sponsor: Istanbul University - Cerrahpasa

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): July 30, 2026

Study Registration Dates

• First Submitted: December 24, 2025
• First Submitted That Met QC Criteria: December 24, 2025
• First Posted (Estimated): January 8, 2026

Study Record Updates

• Last Update Posted (Estimated): January 12, 2026
• Last Update Submitted That Met QC Criteria: January 9, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: exercise; quality of life; liver transplantation; telerehabilitation
• Additional Relevant MeSH Terms: Behavior; Motor Activity; Health Services Administration; Delivery of Health Care; Therapeutics; Patient Care; Health Services; Health Care Facilities Workforce and Services; Rehabilitation; Aftercare; Continuity of Patient Care; Telemedicine; Patient Care Management; Telerehabilitation
• Other Study ID Numbers: IUC-FTR-AA-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No