A Systematic Review of Non-Pharmaceutical Interventions to Reduce Fatigue In Adults Receiving Hemodialysis

Astroth, Kim S.

Friday, 26 July 2013: 10:55 AM

Kim S. Astroth, PhD, RN
Mennonite College of Nursing, Illinois State University, Normal, IL
Cynthia Russell, PhD, RN
School of Nursing, University of Missouri-Kansas City, Kansas City, MO
Janet L. Welch, DNS, RN
Department of Adult Health, Indiana University, Indianapolis, IN

Learning Objective 1: Discuss two types of interventions shown to significantly reduce fatigue in adults receiving hemodialysis.

Learning Objective 2: Describe two barriers to implementation of fatigue interventions.

Purpose: The United States has one of the highest rates of chronic kidney disease stage five, with hemodialysis the most common mode of treatment. Fatigue is a common complaint in 65 to 91% of those receiving hemodialysis. Fatigue can have widespread effects including decreased physical function, quality of life, and ability to perform activities of daily living; increased fatigue is also associated with reduced survival. Because fatigue is frequently reported as bothersome, nurses must discover effective ways to assist patients to manage this symptom. The purpose of this systematic review is to examine effectiveness of non-pharmacologic interventions used to minimize fatigue.

Methods: The databases searched were Academic Search Complete and Cumulative Index to Nursing and Allied Health Literature supported by EBSCO, Cochrane Library, PsycINFO supported by Ovid, PubMed, and Web of Science from the years 1806 to 2011 with 1,388 citations retrieved. Both randomized controlled trials (RCT) and quasi-experimental studies were included.

Results: Twenty-five studies met the inclusion criteria; 11 were RCTs and 14 were quasi-experimental. Fourteen (56%) contained statistically significant improvements in fatigue levels in the study participants. Interventions with significant reductions in fatigue included Eastern-medicine based therapies, such as far infrared rays and acupressure. Exercise interventions with significant fatigue reductions most often included cycling. The studies used self-report measures of fatigue.

Conclusion: The feasibility of implementing Eastern-medicine based therapies may be limited due to lack of experienced providers, and the potential time and cost involved. Replication with fully powered RCT designs is needed to determine the value of interventions with no significant effects. The use of valid and reliable fatigue measures tested in the hemodialysis population is suggested. Use of objective measures of physical fatigue and function as well as self report of perceptions of fatigue may further demonstrate the effectiveness of interventions to reduce fatigue.

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