Loschi TM, Baccan MDTA, Pereira EC, Dellabarba TDLC, Boteon APCS, Boteon YL. Telerehabilitation for frail cirrhotic patients awaiting liver transplant: A safe, effective strategy to improve outcomes. World J Hepatol 2025; 17(10): 110856 [DOI: 10.4254/wjh.v17.i10.110856]
Corresponding Author of This Article
Yuri L Boteon, MD, PhD, FACS, Professor, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, 627/701 Albert Einstein Avenue, São Paulo 05652-900, Brazil. yuri.boteon@einstein.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2025; 17(10): 110856 Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.110856
Telerehabilitation for frail cirrhotic patients awaiting liver transplant: A safe, effective strategy to improve outcomes
Thais Mellato Loschi, Melline D T A Baccan, Elaine C Pereira, Thaise D L C Dellabarba, Amanda P C S Boteon, Yuri L Boteon
Thais Mellato Loschi, Melline D T A Baccan, Elaine C Pereira, Thaise D L C Dellabarba, Amanda P C S Boteon, Transplant Centre, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Thais Mellato Loschi, Yuri L Boteon, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-900, Brazil
Author contributions: Boteon YL, Boteon APCS and Loschi TM conceived the idea and designed the study. Boteon YL, Boteon APCS and Loschi TM performed the literature search; Loschi TM, Baccan MDTA, Pereira EC and Dellabarba TDLC performed the physiotherapy sessions and collected the data; Boteon YL, Boteon APCS and Loschi TM drafted and approved the final manuscript; Baccan MDTA, Pereira EC and Dellabarba TDLC reviewed the draft and approved the final manuscript. All authors contributed to editing and approved the final manuscript version.
Institutional review board statement: This study was reviewed and approved by the local Ethical Review Board (Hospital Israelita Albert Einstein CAAE number 40105420.7.0000.0071, opinion 4.982.351).
Clinical trial registration statement: This study has not been registered at https://clinicaltrials.gov.
Informed consent statement: All the individuals who participated in this study provided their written informed consent prior to study enrolment.
Conflict-of-interest statement: This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement:
No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuri L Boteon, MD, PhD, FACS, Professor, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, 627/701 Albert Einstein Avenue, São Paulo 05652-900, Brazil. yuri.boteon@einstein.br
Received: June 17, 2025 Revised: July 4, 2025 Accepted: September 17, 2025 Published online: October 27, 2025 Processing time: 132 Days and 18 Hours
Abstract
BACKGROUND
Telerehabilitation can help overcome geographic barriers and expand access to physical rehabilitation for patients with chronic liver disease.
AIM
To evaluate the impact of adherence to a videoconference-supervised telerehabilitation programme on frailty, functional capacity, and quality of life in pre-frail or frail cirrhotic patients awaiting liver transplantation.
METHODS
We conducted a non-randomised controlled clinical trial involving patients listed for liver transplantation from January 2021 to May 2023. Frailty was assessed using the Liver Frailty Index (LFI). Participants were enrolled in a 12-week telerehabilitation programme and classified as adherent (≥ 50% sessions) or non-adherent. Functional capacity was measured using the 4-minute step test (4MST), and quality of life was evaluated with the 36-Item Short Form Health Survey (SF-36) questionnaire.
RESULTS
Fifty-seven pre-frail or frail patients were included in the study and enrolled in the telerehabilitation programme. Adherence was observed in 29.8% of participants. At baseline, non-adherent patients had higher mean LFI scores (4.24 vs 4.03, P < 0.001). Over time, the LFI score increased by 0.11 in non-adherent patients, while adherent patients experienced a mean score reduction of 0.54 (final mean LFI score: 3.2). Adherent patients also demonstrated enhanced heart rate responses in the 4MST (P < 0.001) and greater improvements in the physical functioning, vitality, and mental health domains of the SF-36. No serious adverse events were reported.
CONCLUSION
The videoconference-supervised telerehabilitation programme was safe and effective in reducing frailty and improving functional outcomes and quality of life in adherent cirrhotic patients on the liver transplant waitlist.
Core Tip: This study demonstrates that a supervised 12-week telerehabilitation programme is safe, feasible, and effective in addressing frailty among cirrhotic patients awaiting liver transplantation. Adherent patients showed significant improvements in frailty scores (Liver Frailty Index), functional capacity (4-minute step test), and quality of life (36-Item Short Form Health Survey domains). These findings support the use of telerehabilitation as a practical strategy for pre-transplant optimisation in a high-risk, geographically dispersed population.
