Patient and Staff Perceptions of Intradialytic Exercise before and after Implementation: A Qualitative Study

Abstract

IntroductionDespite guidance and evidence for the beneficial effects of intradialytic exercise (IDE), such programmes are rarely adopted within practice and little is known about how they may best be sustained. The Theoretical Domains Framework (TDF) was used to guide the understanding of the barriers and facilitators to initial and ongoing IDE participation and to understand how these are influential at each stage.Materials and MethodsFocus groups explored patient (n=24) and staff (n=9) perceptions of IDE prior to the introduction of a programme and, six months later, face to face semi-structured interviews captured exercising patients (n=11) and staffs’ (n=8) actual experiences. Data were collected at private and NHS haemodialysis units within the UK. All data were audio-recorded, translated where necessary, transcribed verbatim and subject to framework analysis.ResultsIDE initiation can be facilitated by addressing the pre-existing beliefs about IDE through the influence of peers (for patients) and training (for staff). Participation was sustained through the observation of positive outcomes and through social influences such as teamwork and collaboration. Despite this, environment and resource limitations remained the greatest barrier perceived by both groups.ConclusionsNovel methods of staff training and patient education should enhance engagement. Programmes that clearly highlight the benefits of IDE should be more successful in the longer term. The barrier of staff workload needs to be addressed through specific guidance that includes recommendations on staffing levels, roles, training and skill mix.

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

“…Poor physical condition including a reduced walking ability, and symptoms associated with patient's disease and treatment regime such as fatigue, tiredness, pain, shortness of breath, lower extremity ulcers, and weakness were common barriers to exercise, as were existing musculoskeletal injuries or concerns, previous surgeries, and existing co‐morbidities, for example, depression . Given this high level of comorbidity, HCPs felt that they needed to be upskilled in terms of equipment use and exercise counseling skills to enable them to promote exercise …”

“…Lack of awareness of exercise recommendations, opportunities to exercise, and a general lack of information including how to exercise at an appropriate intensity, were considered barriers to exercise by patients. A lack of awareness of exercise guidelines was also indicated as a barrier to exercise promotion by HCPs …”

“…Health care professionals, friends and family, and peer support were reported to be influential for encouraging exercise . However, the current lack of an “exercise culture” for dialysis patients was a reported barrier .…”

“…Exercise was perceived as a way to develop camaraderie and positive common identities with others . Still, HCPs described a lack of support from management, and felt that it would be beneficial to have a dedicated exercise professional to promote and engage patients with exercise …”

A Qualitative Study to Explore Patient and Staff Perceptions of Intradialytic Exercise

“…However, few studies have explored the perspectives of dialysis staff (15,16) or the contextual factors that influence IDE uptake (17). Understanding the perspectives of both those delivering and receiving IDE can improve the design and implementation of interventions (18).…”