Mo1053factors Influencing Dropout From Physical Function Assessment Programs Among Patients Receiving Maintenance Hemodialysis

Abstract

Background and Aims Continuing participation in physical function assessment programs is a critical component of treatment for patients undergoing hemodialysis (HD). Maintaining physical function through participation in a physical function assessment program is important to prevent adverse events in the clinical field of nephrology. Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care for patients receiving hemodialysis (HD). However, the factors related to patients’ continuation of a physical function assessment program while undergoing HD remain unknown. We aimed to investigate the predictors associated with dropout from a physical function assessment program among patients receiving outpatient HD. Method In 2016, Seirei Sakura Citizen Hospital initiated a physical function assessment program for patients receiving outpatient HD. This retrospective cohort study included 230 patients receiving HD who participated in the first physical function assessment program in 2016. Following the initial visit, all patients were invited to complete a physical function assessment once a year. We assessed self-efficacy (SE), short physical performance battery (SPPB), exercise habits, and hand grip and provided patients with appropriate feedback. These measures were performed before the hemodialysis session. Laboratory Data and dialysis status were also collected. Participants were tracked for three years after their first physical function assessment to determine their attendance rate. Patients were provided with four opportunities for participation, including the initial assessment. The program's participation rate was defined as the number of program sessions in which the patient actually participated and the percentage (%) of the four physical functioning assessment visits attended. Patients were then divided into a continuation group (> 50% participation, including the initial assessment) and a dropout group (≤ 50% participation, including the initial assessment). Multivariate logistic regression analyses were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the continuation group to determine the predictors of dropout from the physical function assessment program. Ethical approval was provided by Seirei Sakura Citizen Hospital,and written informed consent. Results A total of 230 patients receiving outpatient HD were invited to participate in the study. Among these, 78 patients refused to participate, 45 participants died or changed clinic within three years of obtaining baseline measurements, and six patients had missing data. Therefore, the final analysis included 101 patients undergoing HD. The continuation and dropout groups included 43 and 58 patients, respectively. SE (continuation: 13.0 ± 4.3 points; dropout: 9.8 ± 4.8 points) and age (continuation: 65.7 ± 10.4 years; dropout: 61.2 ± 12.2 years) were significantly higher in the continuation group than in the dropout group (p = 0.001, p = 0.047, respectively). Multivariate logistic regression analyses indicated that only SE (OR: 1.192, 95% CI: 1.088–1.319) remained a significant predictor after adjustment (p < 0.05). Conclusion Our data demonstrate that exercise-related SE and age significantly influenced dropout from the physical function assessment program; in particular, SE was a strong predictor of dropout, possibly because the patients with high SE may have had positive feelings about exercise based on previous experience. The older patients may have had a smaller social circle and more time to spare and been more aware of their health and desires. There is a need to evaluate SE to prevent dropout from physical functioning assessment programs. Interventions designed to enhance exercise-related SE may improve program retention among patients with HD.