Home-Based Liver Frailty Intervention Shows Feasibility in Pilot Study

Key Takeaways

• A home-based liver frailty intervention using remote monitoring with home equipment and app-based support was reported to be feasible.
• Adherence was partial, but retention remained high and remote frailty assessment was completed during follow-up.
• Modest improvement in liver frailty index was observed, while PROMIS physical function was unchanged and no intervention-related adverse events were reported.

The pilot paired individualized exercise with home equipment, smartphone-based exercise support, biweekly follow-up calls, and monthly remote frailty assessments. Participants were adults undergoing outpatient transplant evaluation or already waitlisted, with activities designed to take place outside the clinic. Eligible patients had access to a smartphone, tablet, or computer, enabling remote exercise instruction and monitoring.

54 patients completed enrollment after a baseline physical therapy evaluation and initiation of app-based home exercise. Frailty testing was repeated monthly via videoconference, and PROMIS physical function surveys were collected remotely by email. Using those assessments and biweekly calls, a physical therapist adjusted home exercise plans during follow-up when needed. Among surveyed participants, most reported the application was easy to use and the equipment was helpful, and 73% completed at least one remote frailty assessment. The intervention centered on home participation, with recurring remote check-ins supporting both measurement and exercise adjustments.

Researchers reported a mean adherence rate of 51% in the enrolled cohort. Adherence at 1 month and 3 months were 62% and 60%, respectively. Overall, 56% of participants were classified as fully or partially adherent to the prescribed exercise schedule. Retention was 100% at 1 month and 94% at 3 months, even as adherence declined over time.

The investigators observed a small improvement in liver frailty index in the intervention group, from 3.59 to 3.48 (p=0.05). The retrospective standard-of-care comparison group did not show a significant change over a similar follow-up period. PROMIS physical function scores were unchanged over follow-up, and no intervention-related adverse events were reported. Overall, the pilot paired modest frailty improvement with stable patient-reported function and no reported intervention-related safety events.