Impact of measurement timing on reproducibility of testing among haemodialysis patients

Hemodiàlisis; Exercici físic; Test d'activitat físicaHemodiálisis; Ejercicio físico; Test de actividades funcionalesHemodialysis; Exercise; Functional activity testAccurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland-Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion, the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test-retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed

Evaluation of reliability in functional assessment tools in patients on hemodialysis

Cada vez es más frecuente promocionar programas de ejercicio físico en pacientes en hemodiálisis. Se puede valorar la condición física de estos pacientes y el resultado de dichos programas con diferentes pruebas funcionales

Effect of a Virtual Reality Exercise on Patients Undergoing Haemodialysis: A Randomised Controlled Clinical Trial Research Protocol

High levels of inflammatory markers have been associated with a greater deterioration of renal function and cardiovascular morbidity and mortality. For its part, physical exercise has been shown to be beneficial in improving the functional, psychological, and inflammatory states of patients with chronic kidney failure (CKF) undergoing haemodialysis (HD) treatment, improving their health-related quality of life. In recent years, virtual reality (VR) has been studied and described as an effective and safe tool that improves patients’ adherence to exercise programs. For these reasons, we propose to analyse the effect of VR exercise on the functional, psychological, and inflammatory states of patients on HD, as well as their levels of adherence to exercise, and compare them with static pedalling exercises. We will randomise 80 patients with CKF into two blind groups: an experimental group, which will carry out an intradialytic exercise program with non-immersive VR (n = 40), and a control group, which will exercise with a static pedal (n = 40). Functional capacity, inflammatory and phycological status, and exercise adherence will be analysed. Higher levels of adherence to exercise are expected in the VR group, which will have greater effects on the patients’ functional capacity and psychological and inflammatory status. Keywords: end-stage kidney disease; renal dialysis; inflammation; physical fitness; psychological wellness; physical activity; virtual realitySección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería)Fac. de Enfermería, Fisioterapia y PodologíaTRUEpu

Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis

[EN] Background Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. Materials and methods Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. Results The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. Conclusion The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.Funding was received from a research prize awarded by the nonprofit organization 'Fundacion Renal Tomas de Osma' as well as from a research grant (IDOC 17-19), a research project (FUSP-BS-PPC14/2017) grant from the Universidad Cardenal Herrera-CEU and a research project (PID2019-108814RA-100) from the Spanish Government 'Ministerio de Ciencia e Innovacion'.García-Testal, A.; Martínez-Olmos, FJ.; Gil-Gómez, J.; Villalón-Coca, J.; Ortiz-Ramón, R.; Cana-Poyatos, A.; García-Maset, R.... (2022). Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis. BMC Nephrology. 23(1). https://doi.org/10.1186/s12882-022-02859-823

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session

[EN] Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.Funding included a research project (PID2019-108814RA-I00) supported by the Spanish Government 'Ministerio de Ciencia e Innovacion', a research prize awarded by the nonprofit organization Fundacion Renal Tomas de Osma, as well as from a research grant (IDOC 17-19 and PPC14/2017) awarded by the Universidad Cardenal Herrera CEU.García-Testal, A.; Martínez-Olmos, FJ.; Gil-Gómez, J.; López-Tercero, V.; Lahoz-Cano, L.; Hervás-Marín, D.; Cana-Poyatos, A.... (2023). Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session. Healthcare. 11(1). https://doi.org/10.3390/healthcare1101007911

Test-retest reliability and minimal detectable change scores for the short physical performance battery, one-legged standing test and timed up and go test in patients undergoing hemodialysis

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients ( 0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.This project is supported by “Ayudas para la realización de proyectos de Investigación+Docencia en la CEU-UCH 2017-2018” code IDOC17/19 and we do not have a conflict of interest.https://doi.org/10.1371/journal.pone.020103513pubpub

Psychometric Properties and factor structure of the spanish version of the HC-PAIRS questionnaire

Objective To develop a Spanish version of the Health Care Providers" Pain and Impairment Relationship Scale (HC-PAIRS) and to test its psychometric properties. Methods A forward and backward translation methodology was used to translate the questionnaire, which was then applied to 206 participants (174physiotherapy students and 32 family physicians). The intraclass correlation coefficient was calculated to assess testretest reliability. Internal consistency was evaluated using Cronbach"s alpha and item analysis. Construct validity was measured using Pearson correlation coefficients between HC-PAIRS and FABQ, FABQ-Phys, FABQ-Work and the responses given by participants to three clinical case scenarios. An exploratory factor analysis was carried out following the Kaiser normalization criteria and principal axis factoring with an oblique rotation (quartimax). Sensitivity to change was assessed after a teaching module. Results Testretest reliability was ICC 0.50 (p\0.01)and Cronbach"s alpha was 0.825. The HC-PAIRS scores correlated significantly with the scores of the FABQ and also with the recommendations for work and activity given by the participants in the three clinical case scenarios. Sensitivity to change test showed an effect size of 1.5, which is considered a large change. Factor analysis suggests that the Spanish version of HC-PAIRS measures a unidimensional construct. Conclusion The Spanish version of the HC-PAIRS has proven to be a reliable, valid and sensitive instrument to assess health care providers" attitudes and beliefs about LBP. It can be used in evaluating clinical practice and in undergraduate acquisition of skills and knowledge

Evaluación de la fiabilidad en instrumentos de valoración funcional en pacientes en hemodiálisis

Introducción: Cada vez es más frecuente promocionar programas de ejercicio físico en pacientes en hemodiálisis. Se puede valorar la condición física de estos pacientes y el resultado de dichos programas con diferentes pruebas funcionales. Objetivo: Valorar la fiabilidad en términos de concordancia interobservador de las mediciones de capacidad funcional y fuerza muscular en pacientes en hemodiálisis. Material y Método: 30 pacientes en hemodiálisis realizaron una batería de pruebas funcionales en dos fases: Short Physical Performance Battery, equilibrio estático monopodal, Timed Up and Go, Test Sit-to-stand-To-Sit-5, Sit-to-stand-To-Sit-10, Sit-to-stand-To-Sit-60, fuerza de tríceps sural, 6 minutos marcha y dinamometría de la mano. Resultados: El índice de correlación intraclase para la fiabilidad interobservador fue para el test Sit-to-stand-To-Sit-5: 0,779; velocidad en 4 metros: 0,820; puntuación total Short Physical Performance Battery: 0,807; Sit-to-stand-To-Sit-10: 0,908; Sit-to-stand-To-Sit-60: 0,865; 6 minutos marcha: 0,897; Equilibrio monopodal: 0,925; Timed Up and Go: 0,918; Fuerza de tríceps sural derecho: 0,702; Fuerza de tríceps sural izquierdo: 0,995; dinamometría mano derecha con apoyo: 0,952; dinamometría mano izquierda con apoyo: 0,897; dinamometría mano derecha sin apoyo: 0,973; dinamometría mano izquierda con apoyo: 0,964. Conclusiones: La fiabilidad interobservador en la mayoría de las pruebas es alta, por lo que se puede aceptar que la valoración del estado funcional del paciente y de los resultados de los programas destinados a promocionar el ejercicio lo lleven a cabo diferentes observadores experimentados, lo que facilitaría el seguimiento de los pacientes

Opinión de los pacientes tras un programa de ejercicio físico domiciliario

Introducción. Las personas con enfermedad renal deben recibir una atención integral que incluya programas de ejercicio físico adaptado a sus necesidades. Objetivo. Evaluar la satisfacción de los pacientes con enfermedad renal crónica en estadios IV y V ante un programa de ejercicio físico domiciliario. Material y métodos. Estudio descriptivo transversal en pacientes que realizaron un programa completo de entrenamiento físico domiciliario de 12 semanas de duración. Tras esta intervención, respondieron de forma anónima a un cuestionario ad-hoc validado por expertos, sobre su opinión acerca del programa. Resultados. Participaron 62 pacientes. 24 estaban en programa de hemodiálisis, 17 en diálisis peritoneal y 7 en situación de enfermedad renal crónica estadio IV. 34 eran hombres. La edad media fue de 67,4±14,9 años. 52 pacientes realizaron el programa solos en su domicilio. 33 de los pacientes les pareció muy correcto que el programa fuera domiciliario, 15 correcto y 2 poco correcto. 47 de los participantes consideraron muy correcto que la persona que dirigiera el programa fuera una enfermera conocida. 19 consideró que tras el programa habían mejorado mucho, 14 que habían mejorado, 9 que habían mejorado poco y 3 que no habían mejorado. 39 estuvieron muy satisfechos de haber podido participar en el programa, 6 satisfechos, 1 poco satisfecho y 1 de los pacientes no estuvo satisfecho. No hubo diferencias significativas en las respuestas en relación al sexo, edad, tipo de tratamiento, o realizar el programa solo o acompañado. Conclusiones.

{'en_US': 'Results of a home physical exercise program in patients with kidney disease', 'es_ES': 'Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal'}

Introducción: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. Objetivo: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. Material y Método: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. Resultados: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4 ±14,9 años. La velocidad de la marcha en 4metros aumentó en 0,18 m/s (IC:95% 0,08–0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95% 0.6–2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). Conclusión: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5