Sharp John, Wild Matt R, Gumley Andrew I, Deighan Christopher J
Division of Community Based Sciences, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, Lanarkshire, UK.
Am J Kidney Dis. 2005 Jun;45(6):1046-57. doi: 10.1053/j.ajkd.2005.02.032.
Adhering to fluid restrictions represents one of the most difficult aspects of the hemodialysis treatment regimen. This report describes a randomized controlled trial of a group-based cognitive behavioral intervention aimed at improving fluid-restriction adherence in patients receiving hemodialysis. It was hypothesized that the intervention would improve adherence, measured by means of interdialytic weight gain (IWG), without impacting negatively on psychosocial functioning.
Fifty-six participants receiving hemodialysis from 4 renal outpatient settings were randomly assigned to an immediate-treatment group (ITG; n = 29) or deferred-treatment group (DTG; n = 27). Participants were assessed at baseline, posttreatment, and follow-up stages. Treatment consisted of a 4-week intervention using educational, cognitive, and behavioral strategies to enhance effective self-management of fluid consumption.
No significant difference in mean IWGs was found between the ITG and DTG during the acute-phase analysis (F(1,54) = 0.03; P > 0.05). However, in longitudinal analysis, there was a significant main effect for mean IWG (F(1.76,96.80) = 9.10; P < 0.001) and a significant difference between baseline and follow-up IWG values (t55 = 3.85; P < 0.001), reflecting improved adherence over time. No adverse effects of treatment were indicated through measures of psychosocial functioning. Some significant changes were evidenced in cognitions thought to be important in mediating behavioral change.
The current study provides evidence for the feasibility and effectiveness of applying group-based cognitive behavior therapy to enhance adherence to hemodialysis fluid restrictions. Results are discussed in the context of the study's methodological limitations.
坚持液体限制是血液透析治疗方案中最困难的方面之一。本报告描述了一项随机对照试验，该试验采用基于小组的认知行为干预，旨在提高接受血液透析患者的液体限制依从性。研究假设该干预措施将提高依从性，通过透析间期体重增加（IWG）来衡量，且不会对心理社会功能产生负面影响。
从4个肾脏门诊机构招募的56名接受血液透析的参与者被随机分配到即时治疗组（ITG；n = 29）或延迟治疗组（DTG；n = 27）。在基线、治疗后和随访阶段对参与者进行评估。治疗包括为期4周的干预，采用教育、认知和行为策略来加强对液体摄入的有效自我管理。
在急性期分析中，ITG和DTG之间的平均IWG没有显著差异（F(1,54) = 0.03；P > 0.05）。然而，在纵向分析中，平均IWG有显著的主效应（F(1.76,96.80) = 9.10；P < 0.001），并且基线和随访IWG值之间存在显著差异（t55 = 3.85；P < 0.001），这反映出随着时间的推移依从性有所提高。通过心理社会功能测量未发现治疗的不良反应。在被认为对介导行为改变很重要的认知方面有一些显著变化。
本研究为应用基于小组的认知行为疗法提高血液透析液体限制依从性的可行性和有效性提供了证据。在研究方法局限性的背景下对结果进行了讨论。
