TY - JOUR
T1 - Implementing a theory-based intradialytic exercise programme in practice
T2 - A quality improvement project
AU - Young, Hannah M.L.
AU - Jeurkar, Sushant
AU - Churchward, Darren R.
AU - Dungey, Maurice
AU - Stensel, David J.
AU - Bishop, Nicolette C.
AU - Greenwood, Sharlene A.
AU - Singh, Sally J.
AU - Smith, Alice C.
AU - Burton, James O.
N1 - Funding Information:
The research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre and partly funded by the Stoneygate Trust. H.M.L.Y. and J.O.B. are supported by grants from the NIHR (grant award numbers DRF-2016-09-015 and CS-2013-13-014). S.J.S. is supported by the Collaboration for Leadership in Applied Health Research and Care East Midlands. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background. Research evidence outlines the benefits of intradialytic exercise (IDE), yet implementation into practice has been slow, ostensibly due to a lack of patient and staff engagement. The aim of this quality improvement project was to improve patient outcomes via the introduction of an IDE programme, evaluate patient uptake and sustainability and enhance the engagement of routine haemodialysis (HD) staff with the delivery of the IDE programme. Methods. We developed and refined an IDE programme, including interventions designed to increase patient and staff engagement that were based on the Theoretical Domains Framework (TDF), using a series of ‘Plan, Do, Study, Act’ (PDSA) cycles. The programme was introduced at two UK National Health Service HD units. Process measures included patient uptake, withdrawals, adherence and HD staff involvement. Outcome measures were patient-reported functional capacity, anxiety, depression and symptomology. All measures were collected over 12 months. Results. A total of 95 patients were enrolled in the IDE programme; 64 (75%) were still participating at 3 months, decreasing to 41 (48%) at 12 months. Adherence was high (78%) at 3 months, decreasing to 63% by 12 months. The provision of IDE by HD staff accounted for a mean of 2 (5%) sessions per 3-month time point. Patients displayed significant improvements in functional ability (P ¼ 0.01) and a reduction in depression (P ¼ 0.02) over 12 months, but the effects seen were limited to those who completed the programme. Conclusions. A theory-based IDE programme is feasible and leads to improvement in functional capacity and depression. Sustaining IDE over time is complicated by high levels of patient withdrawal from the programme. Significant change at an organizational level is required to enhance sustainability by increasing HD staff engagement or access to professional exercise support.
AB - Background. Research evidence outlines the benefits of intradialytic exercise (IDE), yet implementation into practice has been slow, ostensibly due to a lack of patient and staff engagement. The aim of this quality improvement project was to improve patient outcomes via the introduction of an IDE programme, evaluate patient uptake and sustainability and enhance the engagement of routine haemodialysis (HD) staff with the delivery of the IDE programme. Methods. We developed and refined an IDE programme, including interventions designed to increase patient and staff engagement that were based on the Theoretical Domains Framework (TDF), using a series of ‘Plan, Do, Study, Act’ (PDSA) cycles. The programme was introduced at two UK National Health Service HD units. Process measures included patient uptake, withdrawals, adherence and HD staff involvement. Outcome measures were patient-reported functional capacity, anxiety, depression and symptomology. All measures were collected over 12 months. Results. A total of 95 patients were enrolled in the IDE programme; 64 (75%) were still participating at 3 months, decreasing to 41 (48%) at 12 months. Adherence was high (78%) at 3 months, decreasing to 63% by 12 months. The provision of IDE by HD staff accounted for a mean of 2 (5%) sessions per 3-month time point. Patients displayed significant improvements in functional ability (P ¼ 0.01) and a reduction in depression (P ¼ 0.02) over 12 months, but the effects seen were limited to those who completed the programme. Conclusions. A theory-based IDE programme is feasible and leads to improvement in functional capacity and depression. Sustaining IDE over time is complicated by high levels of patient withdrawal from the programme. Significant change at an organizational level is required to enhance sustainability by increasing HD staff engagement or access to professional exercise support.
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U2 - 10.1093/ckj/sfy050
DO - 10.1093/ckj/sfy050
M3 - Article
AN - SCOPUS:85062014451
SN - 2048-8505
VL - 11
SP - 832
EP - 840
JO - CKJ: Clinical Kidney Journal
JF - CKJ: Clinical Kidney Journal
IS - 6
ER -