The purpose of this study was to examine the effects of a 12- week nurse-led case management program on home exercise training for maintenance hemodialysis patients.The interventions aimed at increasing physical function, improving patients’ perceived exercise benefits, removing perceived exercise barriers, enhancing health-related quality of life, and relieving depressive symptom for the patients.
The study was a two-group randomized, controlled trial. Ninety participants were recruited from the hemodialysis units of two tertiary hospitals in Nanjing, China in 2013. They were randomly assigned to either study group (n = 45) or comparison group (n = 45). Participants in both groups received the in-center exercise training (20 minutes) before hemodialysis sessions weekly for 6 weeks and were instructed to perform exercise at home. The in-center training was conducted by the researcher with a group of four-to six participants focusing on flexibility and strengthening exercise only. Patients were encouraged to have cardiovascular exercises at home which will improve their cardiovascular conditions and endurance. The list of cardiovascular exercise included brisk walking, bicycling, jogging. Participants in the study group were instructed to start walking or brisk walking at low duration and gradually progress to a maximum of 30 minutes daily per week. To facilitate exercise progression, the nurse case managers discussed exercise benefits, explored exercise barriers and developed mutual goals with patients. The nurse will motivate them and check the exercise behaviors to ensure adherence to the recommended exercise regime. The nurse case managers interviewed the study group patients weekly for six weeks and biweekly for another six weeks. Participants in the comparison group only participated in the in-center exercise training. The control group patients received usual care from the nurse without the interviews and mutual goals developed. Gait speed (both normal gait speed and fast gait speed), 10-repetition sit-to-stand (10-STS), health-related quality of life, perceived exercise benefits and barriers, and depressive symptom were measured at baseline, 6- and 12-week. Data were analyzed by the two-way repeated-measures ANOVA with an intention-to-treat analysis. Missing values were replaced by the last observed values from the same participants.
For fast gait speed test, Repeated-measures ANOVA showed a significant difference between groups across the three time points (F=4.79, p=0.031). For 10-STS performance, significant within-group effect (F=21.91, p=0.000) was observed for both groups. For health-related quality of life, a significant difference was found between the groups in the subscale for Symptoms of Kidney Disease (F=5.60, p=0.020), and significant within-group differences were noted from the study group in the subscale for Burden of Kidney Disease (F=3.51, p=0.041) and Mental Component Summary (F=3.37, p=0.037). There were significant within-group differences in the perceived benefits and perceived barriers scores (F=15.55, p=0.000; F=13.79, p=0.000, respectively), and both the study group and comparison groups seemed to improve over time; while no significant difference for the between-group effects. The scores for Depressive symptom decreased for both groups, there were no significant differences for between and within group effects. No injuries were observed during the program.
The findings reinforce the notion that exercise is safe and beneficial for hemodialysis patients. The structured 12-week nurse-led case management program on home exercise training is practical and effective to improve the physical function and health-related quality of life of the patients.