Farragher Janine F, Polatajko Helene J, McEwen Sara, Jassal Sarbjit V
Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
Division of Nephrology, University Health Network, Toronto, ON, Canada.
Can J Kidney Health Dis. 2020 Apr 16;7:2054358120916297. doi: 10.1177/2054358120916297. eCollection 2020.
Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education (EME) is a fatigue management approach that teaches people to use practical strategies (eg, prioritizing, using efficient body postures, organizing home environments) to manage their energy expenditure during everyday life.
The aim of this study is to explore whether EME is associated with improvements in fatigue and life participation in adults on chronic dialysis.
Five single-case interrupted time-series AB studies, and follow-up qualitative interviews.
The hemodialysis and peritoneal dialysis units at an academic hospital in Toronto, Canada.
In total, 5 patients on chronic dialysis therapy were purposively selected to represent diversity in age, gender, and modality.
Brief questionnaires assessing fatigue and life participation were administered weekly during the baseline and intervention periods. Additional validated questionnaires (the Fatigue Impact Scale, 36-Item Short-Form Health Survey [SF-36] Vitality Scale, and Canadian Occupational Performance Measure) were also administered at baseline and post-intervention.
All participants underwent "The PEP Program," a personalized, web-supported EME program designed to meet the needs of people on dialysis. During the program, participants complete 2 brief web modules about energy management, and then use energy management principles and a problem-solving framework to work on 3 life participation goals during sessions with a trained program administrator. Data were analyzed using visual analysis and the Tau- statistic for the weekly time-series data, and thematic analysis for the qualitative interviews.
Three of 5 participants displayed a consistently positive response to the Personal Energy Planning (PEP) program across multiple measures of fatigue and life participation. Tau- effect size estimates ranged from small to moderate, according to the time-series data. All 5 participants expressed that the program had benefited them in qualitative follow-up interviews, with the most common reported benefit being that the program made day-to-day activities easier. The format of the program was also said to be feasible and convenient.
An exploratory, proof-of-concept study that used a small set of participants and lacked an active control comparison.
The PEP program might have potential for improving fatigue-related outcomes in people on chronic dialysis. Larger, controlled studies of the program are warranted.
疲劳及其对生活参与度的负面影响是接受慢性透析治疗的患者的首要研究重点。能量管理教育（EME）是一种疲劳管理方法，教导人们运用实用策略（例如，确定优先次序、采用高效身体姿势、整理家庭环境）来管理日常生活中的能量消耗。
本研究旨在探讨能量管理教育是否与改善慢性透析成年患者的疲劳及生活参与度相关。
五项单病例中断时间序列AB研究及后续定性访谈。
加拿大多伦多一家学术医院的血液透析和腹膜透析科室。
总共特意挑选了5名接受慢性透析治疗的患者，以代表年龄、性别和治疗方式的多样性。
在基线期和干预期每周发放评估疲劳和生活参与度的简短问卷。在基线期和干预后还发放了其他经过验证的问卷（疲劳影响量表、36项简短健康调查[SF-36]活力量表和加拿大职业表现测量工具）。
所有参与者均接受了“PEP计划”，这是一个个性化的、有网络支持的能量管理教育计划，旨在满足透析患者的需求。在该计划中，参与者完成两个关于能量管理的简短网络模块，然后在与一名经过培训的计划管理员的课程中，运用能量管理原则和问题解决框架来制定3个生活参与目标。使用视觉分析和针对每周时间序列数据的Tau统计量对数据进行分析，对定性访谈进行主题分析。
5名参与者中有3名在多项疲劳和生活参与度测量指标上对个人能量规划（PEP）计划始终表现出积极反应。根据时间序列数据，Tau效应大小估计值范围从小到中等。所有5名参与者在定性随访访谈中均表示该计划对他们有益，最常提到的益处是该计划使日常活动变得更轻松。该计划的形式也被认为是可行且方便的。
一项探索性的概念验证研究，使用的参与者数量较少且缺乏积极对照比较。
PEP计划可能有改善慢性透析患者疲劳相关结局的潜力。有必要对该计划进行更大规模的对照研究。
