Addressing feasibility challenges to delivering intradialytic exercise interventions: a theory-informed qualitative...

Area of Science:

• Nephrology
• Exercise Physiology
• Health Services Research

Background:

• Intradialytic exercise (IDE) shows potential for improving physical function and quality of life in hemodialysis patients.
• Feasibility challenges have hindered the widespread adoption of IDE into routine hemodialysis care.
• A qualitative study was conducted to explore barriers and enablers for IDE implementation.

Purpose of the Study:

• To identify barriers and enablers to implementing intradialytic exercise (IDE) in hemodialysis settings.
• To generate evidence-based solutions and a feasibility checklist for IDE adoption.
• To inform strategies for successful integration of IDE into standard care.

Main Methods:

• A multicenter qualitative feasibility study involving 43 semistructured interviews with healthcare providers and patients.
• Data collected from 12 hospitals in Ontario, Canada.
• Analysis employed the Theoretical Domains Framework and directed content analysis.

Main Results:

• Key barriers included lack of staff expertise, uncertainty about risks/benefits, workload concerns, and logistical issues (space, equipment).
• Enablers identified were the presence of local champions and positive patient experiences.
• Actionable solutions and a 47-item feasibility checklist were developed.

Conclusions:

• Identified barriers and enablers, along with practical solutions and a checklist, can facilitate IDE implementation.
• These resources aim to support diverse clinical and research settings in overcoming challenges to IDE delivery.
• Successful IDE integration can enhance patient physical function and quality of life.