Increasing Accessibility to Intradialytic Cycling in Rural and Remote Settings: Program Report.

Area of Science:

• Nephrology
• Exercise Physiology
• Telehealth

Background:

• Rural hemodialysis (HD) patients face limited access to exercise and rehabilitation.
• Intradialytic cycling (IDC) offers benefits for HD symptoms and physical function but lacks accessible expertise.
• Novel virtual assessment protocols are needed to expand IDC to underserved HD units.

Purpose of the Study:

• To implement and evaluate a novel virtual intradialytic cycling (IDC) program for rural hemodialysis (HD) units.
• To assess the feasibility and initial impact of virtual IDC using the RE-AIM framework.
• To improve access to exercise interventions for HD patients in remote settings.

Main Methods:

• Developed and piloted a virtual IDC assessment protocol for rural HD units.
• Utilized telehealth for initial assessments and ongoing follow-up with kinesiologists.
• Collected data based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Main Results:

• Four of 18 (22%) rural HD units adopted the virtual IDC program, below the 30% target.
• Individual participation (Reach) varied widely (1-67%), with only one unit meeting the 30% goal.
• Virtual assessments demonstrated 100% fidelity, but rescheduling occurred due to technical and staffing issues.

Conclusions:

• A protocolized virtual support approach can enhance access to evidence-based treatments like IDC in HD units lacking exercise professionals.
• Improving reach requires early patient education and staff orientation for virtual exercise programs.
• Future efforts should focus on optimizing virtual assessment feasibility and selecting relevant, individualized effectiveness measures.