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Implementing a theory-based intradialytic exercise programme in practice: a quality improvement project.

Hannah M L Young1, Sushant Jeurkar2, Darren R Churchward1

  • 1Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation and John Walls Renal Unit, Leicester General Hospital, Leicester, UK.

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|December 8, 2018
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Summary

Intradialytic exercise (IDE) programs show promise for improving patient functional capacity and reducing depression in hemodialysis patients. However, long-term sustainability requires addressing patient withdrawal and increasing staff engagement in delivering IDE.

Keywords:
end-stage renal diseaseexercisehaemodialysisphysical activityquality improvement

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Area of Science:

  • Nephrology
  • Exercise Physiology
  • Quality Improvement

Background:

  • Intradialytic exercise (IDE) offers benefits for hemodialysis (HD) patients, but implementation is hindered by low patient and staff engagement.
  • A quality improvement project aimed to enhance patient outcomes and engagement with IDE programs in routine HD settings.

Purpose of the Study:

  • To introduce and evaluate a theory-based IDE program to improve patient outcomes.
  • To assess patient uptake, adherence, and sustainability of the IDE program over 12 months.
  • To enhance the engagement of HD staff in delivering the IDE program.

Main Methods:

  • Developed an IDE program using the Theoretical Domains Framework (TDF) and Plan-Do-Study-Act (PDSA) cycles.
  • Implemented the program in two UK National Health Service HD units over 12 months.
  • Collected data on patient uptake, withdrawals, adherence, staff involvement, functional capacity, anxiety, depression, and symptomology.

Main Results:

  • 95 patients enrolled; 48% remained at 12 months, with adherence decreasing from 78% to 63%.
  • IDE provision by HD staff was limited (mean 5% of sessions).
  • Patients completing the program showed significant improvements in functional ability (P=0.01) and reduced depression (P=0.02).

Conclusions:

  • A theory-based IDE program is feasible and improves functional capacity and depression in HD patients.
  • High patient withdrawal rates challenge the long-term sustainability of IDE programs.
  • Organizational changes are needed to boost HD staff engagement and professional exercise support for sustained IDE delivery.