Evaluating Global Physical Function and Psychosocial Status of Liver Transplant Recipients Through 6MWT and SIPAT

Abstract

BACKGROUND: This Doctor of Nursing Practice (DNP) project offers insight into the evaluation tools used for pre-liver transplant patients in regards to their physical and psychosocial wellbeing at Mayo Clinic Arizona (MCA). The tools utilized are the Six Minute Walk Test (6MWT) which assesses physical function and the Stanford Integrated Psychosocial Assessment Tool (SIPAT) which measures psychosocial status. MCA is a large transplant center in the southwest region of the United States, therefore it is important to determine the effects of these particular evaluation tools. In addition, there are multiple variables (age, gender, diagnoses, etc.) discussed in this paper which may also contribute to the patient’s transplant status. OBJECTIVE: The aim of this paper is to determine if there is a relationship between 6MWT and SIPAT and transplant status (transplanted vs. not transplanted). PARTICIPANTS: 113 patients on the MCA liver transplant list between 2105-2017 who were evaluated using the SIPAT and who walked 400 meters or below during the 6MWT at the time of initial transplant evaluation. METHODS: The data was collected retrospectively through a chart review. Descriptive statistics were calculated by transplant status (transplanted vs. not transplanted) and overall for variables of interest in the project. Chi square tests for categorical variables and Kruskall-Wallis rank sum tests for continuous variables were analyzed to look for differences in associations between variables of interest and transplant status. INTERVENTION: The 6MWT and SIPAT scores were assessed along with patient variables (age, gender, diagnosis, MELD score) to determine the quality of the physical function and psychosocial pre-liver transplant evaluation tools currently utilized at MCA and if there is a relationship between patient transplant outcomes. For those patients transplanted, their ICU days immediately following transplant are also of interest. RESULTS: 6MWT distance and MELD score were statistically significant variables. For 6MWT, there was a 14% increase in transplant odds for every increment of 30 meters walked. MELD score was also significant for transplant status as MELD score depicts severity of liver disease. Other variables including the SIPAT total score lacked significance related to transplant outcomes. CONCLUSION: The 6MWT was a predictor of transplant status, where the SIPAT was not at MCA. Neither measures were predictors of ICU days following transplant for the individuals who did receive a liver transplant. Although insightful, additional work is needed to determine the multidimensional model necessary to accurately depict liver transplant patients and their outcomes.