Measurement properties of performance-based measures to assess physical function in chronic kidney disease: recommendations from a COSMIN systematic review

MacRae, Jennifer M.; Harasemiw, Oksana; Lightfoot, Courtney J; Thompson, Stephanie; Wytsma-Fisher, Kathryn; Koufaki, Pelagia; Bohm, Clara; Wilkinson, Thomas J

doi:10.1093/ckj/sfad170

Cited by 5 publications

(2 citation statements)

References 74 publications

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“…The use of standardised outcome measures that address clinical priorities such as fall risk and poor mobility [ 68 ] would facilitate data pooling and enable accurate comparisons between studies [ 69 ]. Future studies may consider outcomes such as the Short Physical Performance Battery [ 70 ] and the mobility component of the Integrated Palliative Outcome Scale-Renal [ 71 ] to assist in quantifying effect sizes and determining clinical importance.…”

Section: Discussionmentioning

confidence: 99%

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Letton,

Trần,

Flower

et al. 2024

J Med Syst

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Physical activity is essential to interrupt the cycle of deconditioning associated with chronic kidney disease (CKD). However, access to targeted physical activity interventions remain under-supported due to limited funding and specialised staff. Digital interventions may address some of these factors. This systematic review sought to examine the evidence base of digital interventions focused on promoting physical activity or exercise and their effect on health outcomes for people living with CKD. Electronic databases (PubMed, CINAHL, Embase, Cochrane) were searched from 1 January 2000 to 1 December 2023. Interventions (smartphone applications, activity trackers, websites) for adults with CKD (any stage, including transplant) which promoted physical activity or exercise were included. Study quality was assessed, and a narrative synthesis was conducted. Of the 4057 records identified, eight studies (five randomised controlled trials, three single-arm studies) were included, comprising 550 participants. Duration ranged from 12-weeks to 1-year. The findings indicated acceptability and feasibility were high, with small cohort numbers and high risk of bias. There were inconsistent measures of physical activity levels, self-efficacy, body composition, physical function, and psychological outcomes which resulted in no apparent effects of digital interventions on these domains. Data were insufficient for meta-analysis. The evidence for digital interventions to promote physical activity and exercise for people living with CKD is limited. Despite popularity, there is little evidence that current digital interventions yield the effects expected from traditional face-to-face interventions. However, 14 registered trials were identified which may strengthen the evidence-base.

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Section: Discussionmentioning

confidence: 99%

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Letton,

Trần,

Flower

et al. 2024

J Med Syst

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“…Muscle function and physical performance were assessed using frequently used and recommended assessments of the lower limb [38]. The sit-to-stand-60 (STS-60) test was employed as a measure of lower body strength and muscle endurance.…”

Section: Physical Performance and Muscle Functionmentioning

confidence: 99%

Novel Assessment of Viscoelastic Skeletal Muscle Properties in Chronic Kidney Disease: Association with Physical Functioning

Wilkinson,

Gore,

Baker

et al. 2023

Physiologia

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Chronic kidney disease (CKD) is characterised by poor physical function. Mechanical muscle properties such as tone, elasticity, and stiffness influence the functional state of the muscle. Measuring these muscle mechanical properties is difficult and data on CKD are sparse. Using a novel myotonometer device, the aims of this study were to compare the viscoelastic muscle properties in CKD patients with previously reported data and to explore the association with muscle function. Non-dialysis-dependent CKD participants were recruited into a cross-sectional study conducted between 2018 and 2020. Muscle properties (tone, stiffness, elasticity) were assessed using a myotonometer (MyotonPRO). Muscle function was assessed using physical performance tests (sit-to-stand 5 and 60, timed up and go, short physical performance battery, gait speed, incremental shuttle walk, postural sway). General linear regression models were used to explore the association between muscle properties and physical function. Thirty-nine participants were included (age 64.2 (SD: 10.4) years; 51% male; eGFR 40.9 (SD: 20.0) mL/min/1.73 m2). Participants with CKD had reduced muscle tone, stiffness, and elasticity compared to previously reported studies. Muscle tone (B = −0.567, p = 0.003) and muscle stiffness (B = −0.368, p = 0.071) were greater in males than females. Increased BMI was associated with lower muscle tone (B = −0.528, p = 0.002) and muscle stiffness (B = −0.577, p = 0.002). No meaningful nor consistent associations were found between these properties and measures of muscle function and physical performance. In conclusion, using a novel handheld myotonometer, this study found that CKD patients exhibit a reduction in muscle tone, stiffness, and elasticity. In a passive state, these viscoelastic muscle properties showed no consistent associations with physical performance.

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Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology

Battaglia,

Baciga,

Bulighin

et al. 2024

J Nephrol

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The Italian Society of Nephrology has tasked its Working Group on Physical Exercise with developing a consensus statement document on physical activity and exercise in patients with chronic kidney disease (CKD). This paper consists of 16 points that were discussed, and approved using the mini-Delphi method by 15 members of the working group. Each statement is based on a comprehensive review of the literature, clinical experience, and expert opinions. Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical function, enhanced cardiometabolic and neuromuscular function, cognitive benefits, and an overall improvement in quality of life. Furthermore, exercise may provide nephroprotection and reduce mortality. These advantages are observed across all CKD stages, whether on conservative therapy or kidney replacement therapy (hemodialysis or peritoneal dialysis), and in kidney transplant recipients. Moreover, when physical activity and exercise training are implemented with appropriate precautions, they are safe in CKD patients. Gradual physical activity and customized exercise programs should be tailored to the patient's exercise tolerance, potentially enhancing compliance. Clinicians are encouraged to use a series of questionnaires and tests to assess the patient's level of physical activity and performance. However, exercise and physical activity are poorly implemented in clinical practice due to many barriers related to patients and healthcare staff. Overcoming these barriers requires the proactive role of the nephrologists, who should actively incorporate exercise training and promote physical activity within routine care plans. Adopting a multidisciplinary team approach, which includes nephrologists, nurses, exercise professionals, and dietitians, is crucial for providing comprehensive rehabilitation for CKD patients. Integrating new technologies and remote check ups could further enhance the effectiveness of these interventions. Graphical abstract

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Measurement properties of performance-based measures to assess physical function in chronic kidney disease: recommendations from a COSMIN systematic review

Cited by 5 publications

References 74 publications

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Novel Assessment of Viscoelastic Skeletal Muscle Properties in Chronic Kidney Disease: Association with Physical Functioning

Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology

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