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Greenwood, Sharlene

Hamilton, Alexander J

Mayes, Juliet

English

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                          Mayes, J., Hamilton, A. J., Greenwood, S., & al, E. (2021). The rapiddevelopment of a novel kidney-specific digital intervention for self-management of physical activity and emotional wellbeing during theCOVID-19 pandemic and beyond: Kidney Beam. Clinical KidneyJournal. https://doi.org/10.1093/ckj/sfab239Peer reviewed versionLicense (if available):CC BYLink to published version (if available):10.1093/ckj/sfab239Link to publication record in Explore Bristol ResearchPDF-documentThis is the accepted author manuscript (AAM). The final published version (version of record) is available onlinevia Oxford University Press at /10.1093/ckj/sfab239. Please refer to any applicable terms of use of the publisher.University of Bristol - Explore Bristol ResearchGeneral rightsThis document is made available in accordance with publisher policies. Please cite only thepublished version using the reference above. Full terms of use are available:http://www.bristol.ac.uk/red/research-policy/pure/user-guides/ebr-terms/© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA. This is an Open Access articledistributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.For commercial re-use, please contact journals.permissions@oup.comORIGINAL UNEDITED MANUSCRIPTThe rapid development of a novel kidney-specific digital intervention for self-management of physical activity and emotional wellbeing during the COVID-19 pandemic and beyond: Kidney Beam Juliet Mayes1, Roseanne E. Billany3, Noemi Vadaszy3, Hannah M.L Young3, Ellen M. Castle1,2, Nicolette C. Bishop6, Kate Bramham1,2, Andrew C. Nixon4, Thomas J. Wilkinson3, Alexander Hamilton5, Zoe L. Saynor7, Joseph Chilcot2, Federica Picariello2, Jamie Macdonald8, Sharlene A. Greenwood1,2  1King’s College Hospital NHS Trust, London, UK 2King’s College London, London, UK 3University of Leicester, Leicester, UK 4Lancashire Teaching Hospitals NHS Foundation Trust, UK 5University of Bristol 6Loughborough University, UK 7School of Sport, Health and Exercise Science, University of Portsmouth, UK 8School of Human and Behavioural Sciences, Bangor University, Wales, UK  Correspondence to: Juliet Mayes; E-mail: juliet.mayes@nhs.net        Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPTIndividuals living with chronic kidney disease (CKD) report high levels of physical inactivity, and poor emotional wellbeing (1). Despite disease-specific guidelines promoting physical activity (PA) participation (2), people living with CKD do not routinely receive PA or emotional wellbeing support as part of their clinical care (3).   The challenge to engage people living with CKD with PA and emotional wellbeing interventions was exacerbated by the COVID-19 global pandemic. Specifically, CKD was identified as a significant risk factor for more severe COVID-19 infection (4, 5), and people with CKD were advised to shield at home. The resultant impact on the physical and emotional wellbeing of these individuals was captured in a Kidney Care UK patient survey, which revealed that 41% of respondents felt anxious, lonely, or isolated during the pandemic (6).   The COVID-19 pandemic led to an increase in the use of digital technology, and ‘eHealth’ interventions that could deliver aspects of usual and enhanced CKD care. This context led to the current authors rapidly developing and rolling-out a kidney-specific PA and emotional wellbeing platform, Kidney Beam (promotion was by social media only; no additional technical or clinical support was offered).  The Kidney Beam programme (https://beamfeelgood.com/home) is a contextually appropriate, theory-informed intervention that was designed to promote digital delivered PA and emotional wellbeing self-management in people living with CKD, as guided by the Behaviour Change Wheel (7). The multi-faceted digital intervention package was composed of online live and on-demand exercise training videos; careful selection of healthcare Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPTprofessional and patient champions; use of email feedback, action planning; and online educational videos and blogs.  A six-month prospective feasibility project was approved by King's College Hospital Research and Innovation team to allow rapid design, delivery, and evaluation of Kidney Beam during the COVID-19 pandemic. The project was funded by Kidney Research UK. All people in the UK living with CKD aged ≥18 years were eligible to sign-up to the platform. Participants consented to complete a voluntary electronic survey on sign-up to the platform, and at 6-months, to establish whether participants were meeting current PA guidelines, investigate perceptions of health, and collect usability and acceptability data about the platform. Data was collected between 1st June 2020 and 30th November 2020.   In total, 959 adults signed up to use the platform within the 6-month time period (see Table 1.0). There was a 43% activation rate (people who sign-up to the platform completing one or more classes), which is higher than the UK national average for digital healthcare interventions. More than 1,900 movement classes were completed during the 6-month time period. 276 participants completed the voluntary survey at baseline, with 85 completing the follow-up survey at 6 months. Results suggest an increase in those participants achieving recommended PA guidelines, and in those participants who perceived their energy levels to be good or very good by the end of the 6-month project (See Table 2.0). Promisingly, 96% of participants surveyed would recommend Kidney Beam, with the biggest reported benefit being that the intervention was kidney-specific and delivered by specialist kidney healthcare professionals.  Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPTDigital health interventions that are co-designed with people living with a long-term health condition may result in better clinical and person-centred outcomes (8, 9). The Kidney Beam programme was rapidly co-developed and delivered with minimal resource during the COVID-19 pandemic. Despite known challenges around digital and health literacy, this digital self-management programme attracted 736 participants living with CKD to sign-up to the platform. A randomised controlled waitlist trial is underway to evaluate feasibility, clinical value and cost-effectiveness of the Kidney Beam programme delivered as part of clinical care (NCT04872933).  ACKNOWLEDGEMENTS We thank Kidney Research UK for rapidly funding this feasibility project and enabling the platform to be free at the point of access for all individuals living with CKD.  CONFLICT OF INTEREST STATEMENT The results presented in this article have not been published previously in whole or part.  AUTHORS’ CONTRIBUTIONS S.A.G and J.M., contributed to acquisition of data; analysis and interpretation of data. S.A.G, J.M, R.E.B, N.V, H.M.L.Y, E.M.C, N.C.B, A.H, Z.L.S, J.C, FP, J.Mc, K.B, A.C.N, T.J.W contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The funders did not have any role in study design; collection, analysis and interpretation of data; writing the report; or the decision to submit the report for publication.  Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPTFUNDING The pilot study was a collaboration between King's College Hospital, Kidney Research UK (KRUK) and Beam, a health-technology platform supporting people with health conditions to stay physically active.   REFERENCES  1. Wilkinson TJ, Clarke AL, Nixon DGD et al. Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study, Nephrology Dialysis Transplantation 2021; 36: 641–649. Available at: https://doi.org/10.1093/ndt/gfz235 2. UKKA guidelines, Clinical Practice Guideline Exercise and Lifestyle in Chronic Kidney Disease, Published April 2021, accessed15.09.2021. Available at: https://ukkidney.org/sites/renal.org/files/Exercise%20and%20Lifestyle%20in%20CKD%20clinical%20practice%20guideline33_v4_FINAL_0.pdf 3. Koufaki P, Greenwood S, Painter P, Mercer T. The BASES expert statement on exercise therapy for people with chronic kidney disease. J Sports Sci. 2015; 33(18):1902-7. doi: 10.1080/02640414.2015.1017733.  4. ERA-EDTA Council, ERACODA Working Group, Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA, Nephrology Dialysis Transplantation, 2021; 36, (1): 87–94, https://doi.org/10.1093/ndt/gfaa314 5. Clark A, Jit M , Warren-Gash C et al.  Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health 2020; 8: e1003–e1017. 6. KCUK Patient Survey Report 2020, accessed 21.06.2021. Available at: https://www.kidneycareuk.org/news-and-campaigns/news/fears-kidney-patients-government-coronavirus-advice-leaves-thousands-dark/ 7. Michie S, Atkins L, West R. (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing. www.behaviourchangewheel.com 8. Kitsiou S, Pare G, Jaana M, Gerber B. Effectiveness of mHealth interventions for patients with diabetes: an overview of systematic reviews. PLoS ONE 2017;12(3):e0173160 9. Widmer RJ, Collins NM, Collins CS, et al. Digital health interventions for the prevention of cardiovascular disease: a systematic review and metaanalysis. Mayo Clinic Proceedings 2015; 90(4):469-80.   Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPTTable 1.0- Demographic data of participants who signed up to use the Kidney Beam platform          Age (years) Total Users (n) Percentage (%) 0-18 0 0 18-25 35 4 25-35 155 16 35-45 205 21 45-55 231 24 55-65 209 22 65-75 86 9 75+ 35 4 Total: 956 100 User type   Living with condition 736 77 Exercise or healthcare practitioner 127 13 Care giver 34 4 Other 50 5 Unknown 12 1 Gender   Male 249 26 Female 707 74 Other 0 0 Kidney Care Clinic   GP 121 25 General Nephrology Clinic 122 25 Low Clearance Clinic 15 3 Peritoneal Dialysis Clinic 23 5 Haemodialysis Clinic 34 7 Kidney Transplant Clinic 153 32 Other 14 3 Total 482 100 Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021ORIGINAL UNEDITED MANUSCRIPT Table 2.0- Pre and Post 6 month participation voluntary survey results   Baseline  n (%) 6 months  n (%) Percentage change baseline to 6 months (Δ%) Achieving 150 minutes of moderate-intensity physical activity per week  83 (30)  43 (60)  100% Achieving 75 minutes of vigorous-intensity physical activity, per week  97 (35)  36 (42)  20 Achieving twice weekly strength training  86 (31)  46 (54)  74 Perceived energy levels to be good or very good  55 (20)  26 (30)  50  Downloaded from https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfab239/6449392 by guest on 06 December 2021

The rapid development of a novel kidney-specific digital intervention for self-management of physical activity and emotional wellbeing during the COVID-19 pandemic and beyond: Kidney Beam

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The rapid development of a novel kidney-specific digital intervention for self-management of physical activity and emotional wellbeing during the COVID-19 pandemic and beyond: Kidney Beam

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