The Effects of a Nurse-led Case Management Programme on Home Exercise Training for Haemodialysis Patients
Condition: Kidney Disease
MeSH terms: Kidney Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to examine the effects of a nurse-led case management programme
      on home exercise training for haemodialysis patients. We hypothesised that: a. There is no
      significant difference in physical functioning between participants receiving the nurse-led
      home exercise training programme and those receiving the comparison care. b. There is no
      difference in depression between participants receiving the nurse-led home exercise training
      programme and those receiving the comparison care. c. There is no difference in quality of
      life and health perception between participants receiving the nurse-led home exercise
      training programme and those receiving the comparison care. d. There is no difference in
      physical activity levels between participants receiving the nurse-led home exercise training
      programme and those receiving the comparison care. e. There is no difference in perceived
      benefits and barriers of exercise between participants receiving the nurse-led home exercise
      training programme and those receiving the comparison care.

      The study was a randomized controlled trial conducted in two haemodialysis units of two
      tertiary hospitals in Nanjing, China. Participants were randomly assigned to either study
      group or comparison group. Participants in both groups received the in-center exercise
      training (20 minutes) before haemodialysis sessions weekly for 6 weeks and were instructed to
      perform exercise at home. The in-center training was focused on flexibility and strengthening
      exercise. 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 motivated them and checked 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 comparison group patients received
      usual care from the nurse without the interviews and mutual goals developed.
    

Detailed description: 
      The duration of interventions was 12 weeks. In-center exercise training sessions were
      available for all participants once a week for 6 weeks. Each session lasted about 20 minutes.
      Participants were instructed to perform flexibility and strength exercise in centres prior to
      the haemodialysis session. The researcher performed exercises with the participants and
      emphasised the importance of self-monitoring during the sessions. Symptoms (such as chest
      pain, dyspnea, dizziness, and leg cramps) and vital signs (blood pressure, heart rate, and
      pulse) were checked before exercise and monitored during the entire exercise session.
      Participants were instructed to self-monitor exercise intensity. The exercise programme was
      pause immediately if the patient was feeling short of breath, chest pain or pressure,
      irregular heartbeats, leg cramps, dizziness or lightheadedness, blurring of vision, or any
      discomfort.

      Intervention group During the study period, participants in the intervention group received
      additional face-to-face interviews conducted by the designated case managers every week for
      six weeks and biweekly for another six weeks. During interviews, patients were instructed to
      start aerobic exercise, such as walking, jogging, cycling, or brisk walking at home at low
      duration and gradually progress to a maximum of 30 minutes daily per week. Apart from aerobic
      exercise, patients were recommended to perform strength exercises twice a week and
      flexibility exercises for every day. The key elements of the interview included: 1)
      assessment of patients' knowledge and exercise behaviour; examining patients' attitudes and
      feelings about being physical activity; 2) explore patients' barriers to exercise and
      perceived benefits; 3) patient education on the benefits of exercise if needed; 4)
      development of mutual goals in an exercise plan; 5) explain the purpose of a recording
      exercise log and instruction in correct way to keep an exercise diary; 6) discuss the
      available supports and resources that could motivate patients to initiate and maintain
      exercise, e.g., centre-based exercise programme, support from family members, health care
      providers, peer patients, and so forth.

      In the follow-up interviews, case managers reviewed the exercise log with participants,
      discussed unpleasant experiences related to exercise, exercise progress, and provided
      encouragement. According to the progress participants made, the exercise goals and plan were
      renewed or revised. Referrals were made as needed.

      Comparison group Participants in the comparison group were advised to participate in the
      in-centre exercise training programme which was available before haemodialysis sessions once
      a week for different shifts of patients. The training session lasted about 20 minutes and
      only flexibility and strength training were provided. During the training sessions, patients
      were advised to increase their daily activity levels.
    

Intervention name(s): Nurse-led interviewing; Brief group exercise
Intervention type(s): Behavioral; Other
Intervention description(s): Participants in experimental arm received regular face-to-face interviews during dialysis sessions conducted by the designated case managers every week for 6 weeks and biweekly for another 6 weeks.; Participants in this arm only participated in the brief in-center exercise training. They received usual care from the nurse without the interviews and mutual goals developed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research