A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

BACKGROUND

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.

OBJECTIVE

The aim of this study is to explore whether EME is associated with improvements in fatigue and life participation in adults on chronic dialysis.

DESIGN

Five single-case interrupted time-series AB studies, and follow-up qualitative interviews.

SETTING

The hemodialysis and peritoneal dialysis units at an academic hospital in Toronto, Canada.

PATIENTS

In total, 5 patients on chronic dialysis therapy were purposively selected to represent diversity in age, gender, and modality.

MEASUREMENTS

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.

METHODS

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.

RESULTS

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.

LIMITATIONS

An exploratory, proof-of-concept study that used a small set of participants and lacked an active control comparison.

CONCLUSIONS

The PEP program might have potential for improving fatigue-related outcomes in people on chronic dialysis. Larger, controlled studies of the program are warranted.