Comparison of two exercise programs for hemodialysis patients, intradialysis vs home based program. Absolute and relative reliability of physical performance testing

• Autores: Lucía Ortega Pérez del Villar
• Directores de la Tesis: Eva Segura Ortí (dir. tes.), Tim Mercer (codir. tes.)
• Lectura: En la Universidad CEU - Cardenal Herrera ( España ) en 2017
• Idioma: inglés
• Tribunal Calificador de la Tesis: Pelagia Koufaki (presid.), Samuel Asensio (secret.), Aránzazu Ruescas Nicolau (voc.)
• Materias:
  • Ciencias médicas
    • Cirugía
      • Fisioterapia
• Enlaces
  • Tesis en acceso abierto en: Repositorio Institucional CEU
• Resumen

  • BACKGROUND: Maintenance hemodialysis (HD) patients reportedly suffer from deterioration in physical functioning. Previous studies have shown that supervised exercise programs are effective and safe for chronic kidney disease patients receiving HD. However, exercise is not routinely undertaken in most HD units.

    OBJECTIVE: The main objectives of this study was (1) to assess the relative and the absolute reliability and to calculate the minimal detectable change of the Short Physical Performance Battery, one leg stance test and Timed Up and Go test; (2) to quantify the degree of functional deterioration experienced by chronic kidney disease patients during a six-month period; and (3) to compare the effects of 16 weeks intradialytic versus HB exercise for HD patients.

    METHODS: Patients with chronic kidney disease were recruited from three HD units from Valencia and Terrassa (Spain). Outcome measures included physical functioning tests such as the Short Physical Performance Battery (SPPB), the One Leg Standing Test (OLST), the Timed Up and Go (TUG), the Sit to Stand 10 and 60 (STS – 10/60), isometric handgrip, the One heel rise, and the 6 minutes walking test (6MWT); habitual physical activity via questionnaires (Human Activity Profile (HAP), and the Physical Activity Scale for Elderly (PASE)); depression (Center for epidemiologic studied depression scale (CES – D)) and health related quality of life (Kidney Disease Quality of Life 36 (KDQoL – 36)).

    OUTCOMES: (1) Intraclass correlation coefficient in the SPPB, OLST and TUG were 0.94, 0.9 and 0.96, while the MDC for each test was 1.7 points, 11.3 seconds and 2.9 seconds, respectively. (2) No significant changes observed in physical deterioration after 6 months. (3) significant group x time interaction effect for the OLST and a significant time effect for the SPPB, TUG, STS – 10, the right and left hand handgrip, the one heel rise for left leg and the 6MWT. In the HB group, we found significant improvements in the SPPB and the TUG, while in the intradialytic group we found significant improvements in the OLST, the STS – 10, the handgrip left hand and the 6 MWT. We found a significant improvement in the activity level over time.

    CONCLUSIONS: (1) The SPPB, OLST and TUG were considered as acceptable reliability in this sample. (2) No significant changes over a 6 months’ period on physical function. (3) Both ID and HB exercise programs for patients with renal failure undertaking HD improved physical function, decreased depression and increased the physical activity level in chronic kidney disease patients in hemodialysis.