Implementing a theory-based intradialytic exercise programme in practice: a quality improvement project
journal contributionposted on 11.06.2018 by Hannah M.L. Young, Sushant Jeurkar, Darren R. Churchward, Maurice Dungey, David Stensel, Nicolette Bishop, Sharlene A. Greenwood, Sally Singh, Alice C. Smith, James O. Burton
Any type of content formally published in an academic journal, usually following a peer-review process.
Background Research evidence outlines the benefits of intradialytic exercise (IDE), yet implementation into practice has been slow, ostensibly due to lack of patient and staff engagement. The aim of this quality improvement project was to improve patient outcomes via the introduction of an IDE programme; evaluate patient uptake, sustainability and enhance the engagement of routine haemodialysis (HD) staff with the delivery of the IDE programme. Methods We developed and refined an IDE programme, including interventions designed to increase patient and staff engagement that were based upon the Theoretical Domains Framework, using a series of ‘Plan, Do, Study, Act’ cycles. The programme was introduced at two UK NHS HD units. Process measures included patient uptake, withdrawals, adherence and HD staff involvement. Outcomes measures were patient-reported functional capacity, anxiety, depression and symptomology. All measures were collected over 12 months. Results 95 patients enrolled in the IDE programme. 64 (75%) were still participating at three months, dropping to 41 (48%) at 12 months. Adherence was high (78%) at three months, dropping to 63% by 12 months. Provision of IDE by HD staff accounted for a mean of 2 (5%) sessions per three-month time point. Patients displayed significant improvements in functional ability (p=0.01), and reduction in depression (p=0.02) over 12 months, but effects seen were limited to those who completed the programme. Conclusions A theory-based IDE programme is feasible and leads to improvement in functional capacity and depression. Sustaining IDE over time is marred by high levels of patient withdrawal from the programme. Significant change at an organisational level is required to enhance sustainability by increasing HD staff engagement or access to exercise professional support.
The research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre and part funded by the Stoneygate Trust. Hannah Young and Dr James Burton are supported by grants from the National Institute of Health Research (NIHR; Grant award number: DRF-2016-09-015 andCS-2013-13-014). SJS is supported by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands.
- Sport, Exercise and Health Sciences