Ju Angela, Scholes-Robertson Nicole, Johnson David W, Cho Yeoungjee, van Zwieten Anita, Manera Karine, Howell Martin, Viecelli Andrea K, Jesudason Shilpanjali, Evangelidis Nicole, Polkinghorne Kevan, Gutman Talia, Wyburn Kate, Craig Jonathan C, Tong Allison
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.
Clin Kidney J. 2020 Feb 4;14(3):831-839. doi: 10.1093/ckj/sfz200. eCollection 2021 Mar.
Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue.
We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application.
Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) 'an expectation of tangible gains from exercise', including strengthening and protecting against bodily deterioration related to dialysis; (ii) 'overcoming physical limitations', meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) 'fear of risks', which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) 'realistic and achievable' exercise, which would ensure initial readiness for uptake; (v) 'enhancing motivation and interest' , which expected to support sustained use of the exercise intervention and (vi) 'ensuring usability of the mobile application' , which would require simplicity, convenience and comprehensibility.
Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.
疲劳是接受透析治疗的患者最重要的症状之一，被指定为该情况下所有临床试验需报告的核心结果。然而，针对疲劳的干预试验却很少。以往患者很少参与干预措施的设计，这可能会限制其可接受性和采用率。当被问及偏好时，他们表示倾向于采用生活方式干预措施，如运动，来改善疲劳。虽然一些研究聚焦于接受血液透析患者的透析期间运动，但患者也表示希望有一种方便的运动方式，能在透析时间之外的自己的时间里，在指导下进行锻炼。为此，有人提出使用手机应用程序作为一种在家进行针对疲劳的运动干预的方式。
我们在澳大利亚举办了一个研讨会，设有五个分组会议，共有24名透析患者（16名血液透析患者和8名腹膜透析患者）以及8名护理人员参加，以确定、排序并讨论针对透析患者疲劳的运动干预措施，以及如何通过移动应用程序来实施这些措施。
在确定的21种运动类型中，排名靠前的是户外散步、在跑步机上行走以及心肺和阻力训练。确定了六个主题：（i）“对运动带来切实益处的期望”，包括增强体质和预防与透析相关的身体机能衰退；（ii）“克服身体限制”，意味着需要解决合并症、基线疲劳和健康状况波动等问题，以便能够进行运动；（iii）“对风险的担忧”，这凸显了运动安全性以及与透析兼容性的重要性；（iv）“现实可行的”运动，这将确保最初易于接受；（v）“增强动力和兴趣”，期望这能支持对运动干预措施的持续使用；（vi）“确保移动应用程序的可用性”，这要求应用程序具备简单、方便和易懂的特点。
患者期望的、有望改善健康结果且安全、现实且易于采用的运动干预措施，可能更容易被透析患者接受。
