Providing Physical Therapy Interventions for a Patient After Heart Transplantation in the Acute Care Setting

Background and Purpose: Heart transplantation frequency is increasing in the United States with 4545 procedures in 2023. Most research for physical therapy interventions for heart transplant (HT) recipients addresses outpatient cardiac rehabilitation with limited research in phase I cardiac rehabilitation. This case report describes clinical decision-making related to physical therapy interventions and demonstrates effectiveness utilizing multiple outcome measures for a HT recipient in phase I cardiac rehabilitation. Case Description: A 60-year-old male received a HT. Physical therapy was initiated 3 days postoperatively with multiple impairments and activity limitations identified. The patient participated in 14 physical therapy sessions over 22 hospital days. In week 1, intervention prescription focused on functional and strength training. In week 2, improved functional status allowed for endurance training. In week 3, balance training and home safety education were added in anticipation of hospital discharge. Outcomes: The patient participated in 100% of sessions in which he was medically stable. The patient demonstrated clinically meaningful improvement in functional capacity on the JH-HLM (5-point improvement, exceeds MDC of 0.6) and in aerobic capacity on the 6MWT (80-meter improvement, exceeds MCID of 54 meters). Discussion and Conclusion: This case report provides a framework for physical therapists regarding intervention prescription, progression, use of outcome measures, and physiologic considerations for a HT recipient participating in phase I cardiac rehabilitation. More research is needed. In conclusion, this case report demonstrates that phase I cardiac rehabilitation is effective in improving functional and aerobic capacity in a HT recipient.