Hemodialysis, Transportation, and Mobility: A Systematic Review From an Occupational Therapy Perspective

Area of Science:

• Nephrology
• Rehabilitation
• Public Health

Background:

• Maintenance hemodialysis requires consistent patient access to treatment facilities.
• Transportation challenges are frequently reported by patients undergoing hemodialysis.
• These barriers can negatively affect treatment adherence and overall health outcomes.

Purpose of the Study:

• To systematically review existing evidence on transportation barriers faced by adults on maintenance hemodialysis.
• To examine the impact of these transportation barriers on treatment adherence, quality of life, and community participation.

Main Methods:

• A systematic literature search was conducted across major databases (MEDLINE, CINAHL, Cochrane Library, ScienceDirect) from 2015 to 2025.
• Eleven English-language studies from eight countries, involving a total of 28 to 115,982 participants, met the inclusion criteria.
• Thematic synthesis was employed to identify recurring transportation-related challenges.

Main Results:

• Four primary themes of transportation barriers were identified: travel distance/time, costs, mode of transport, and service reliability/availability.
• These barriers were found to limit treatment adherence, reduce patient autonomy, and hinder participation in daily activities.
• The collective impact diminished patients' overall quality of life.

Conclusions:

• Transportation is a significant environmental factor limiting occupational performance for individuals on maintenance hemodialysis.
• Occupational therapists play a vital role in assessing transportation needs and implementing supportive interventions.
• Strategies to improve transportation access are essential for enhancing adherence and quality of life in this population.