Development, Validation, and Evaluation of a Nurse-Led Perioperative Staged Exercise Management Program for...

Area of Science:

• Vascular Surgery
• Nephrology Nursing
• Clinical Exercise Physiology

Background:

• Arteriovenous fistula (AVF) is the preferred hemodialysis access, but postoperative exercise guidance and support are often lacking.
• Inconsistent recommendations and limited post-discharge support can hinder optimal AVF function.

Purpose of the Study:

• To develop, validate, and evaluate a nurse-led perioperative staged exercise management program for AVF creation.
• To improve postoperative recovery and AVF maturation through structured exercise interventions.

Main Methods:

• A sequential multiphase study involving evidence review, expert consultation, pilot testing, and a prospective controlled evaluation.
• Adults undergoing radiocephalic AVF creation received either usual care or the intervention program (staged exercise, inpatient instruction, discharge confirmation, digital reminders, follow-up).
• Ultrasound, maturation, and process indicators were assessed; TREND guidelines were followed for reporting.

Main Results:

• The intervention group showed significantly higher brachial artery blood flow and diameter, and radial artery diameter at 8 weeks.
• AVF maturation rates were higher at 8 weeks (95.1% vs. 75.6%) and 12 weeks (100.0% vs. 82.9%) in the intervention group.
• The program demonstrated high adherence, feasibility, and no serious exercise-related adverse events.

Conclusions:

• The nurse-led perioperative staged exercise program is feasible and associated with improved ultrasound and maturation outcomes post-AVF creation.
• High-quality, continuous nursing management is crucial for patient recovery and AVF care, extending beyond one-time education.
• Further multicenter studies are recommended to confirm generalizability and long-term benefits.