Bohm Clara, Schick-Makaroff Kara, MacRae Jennifer M, Tan Maria, Thompson Stephanie
Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Semin Dial. 2019 Jul;32(4):336-350. doi: 10.1111/sdi.12806. Epub 2019 Apr 21.
Exercise improves objective measures of physical function in individuals on hemodialysis, but its effect on patient-reported outcomes (PROs) is largely unknown. We performed a scoping review to characterize the existing knowledge base on exercise and PROs in dialysis patients to make recommendations for future research. We searched Medline, Embase, Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials, CINAHL, and SPORT Discus from inception to November 28, 2018 and then screened results for randomized controlled trials comparing aerobic/resistance exercise, or both, with no exercise in individuals on dialysis that reported results of any PRO. Of 1374 eligible studies, 25 studies met inclusion criteria. Study interventions included aerobic exercise (11 intradialytic and 3 home-based trials); intradialytic resistance exercise (seven studies) and combined aerobic and resistance exercise (six intradialytic and one facility-based trial). The PROs measured included health-related quality of life (n = 19), depression (n = 6), anxiety (n = 3), symptom burden (n = 4), sleep quality (n = 2), restless legs syndrome (n = 2), disability (n = 2), and self-reported physical activity level (n = 4). Only five studies included a PRO as a primary outcome. Studies primarily used broad/generic measures of health-related quality of life and the effect of exercise on symptoms remains relatively unexplored, particularly in peritoneal dialysis populations. Although limited, the role of exercise in improving restless legs was consistent and is a promising outcome for future study. A critical step to improving the quality of the research on this topic includes the use of validated and consistent PRO measures.
运动可改善血液透析患者身体功能的客观指标，但其对患者报告结局（PROs）的影响却 largely unknown。我们进行了一项范围综述，以描述透析患者运动与PROs的现有知识库，为未来研究提出建议。我们检索了Medline、Embase、Cochrane系统评价数据库、Cochrane对照试验中心注册库、CINAHL和SPORT Discus，检索时间从建库至2018年11月28日，然后筛选比较有氧运动/抗阻运动或两者与未运动的透析患者的随机对照试验结果，这些试验报告了任何PRO的结果。在1374项符合条件的研究中，25项研究符合纳入标准。研究干预措施包括有氧运动（11项透析内运动和3项家庭运动试验）、透析内抗阻运动（7项研究）以及有氧运动与抗阻运动相结合（6项透析内运动和1项机构运动试验）。所测量的PROs包括健康相关生活质量（n = 19）、抑郁（n = 6）、焦虑（n = 3）、症状负担（n = 4）、睡眠质量（n = 2）、不安腿综合征（n = 2）、残疾（n = 2）以及自我报告的身体活动水平（n = 4）。只有5项研究将PRO作为主要结局。研究主要使用广泛/通用的健康相关生活质量测量方法，运动对症状的影响仍相对未被探索，尤其是在腹膜透析人群中。尽管有限，但运动在改善不安腿方面的作用是一致的，是未来研究的一个有前景的结果。提高该主题研究质量的关键一步包括使用经过验证且一致的PRO测量方法。
