Rehabilitation improves prognosis and activities of daily living in hemodialysis patients with low activities of daily living

Abstract

ABSTRACT. Background: Activities of daily living (ADL) in aged hemodialysis patients decrease by many factors as hemodialysis therapy, various disease-related complications and underlying disease for rehabilitation. But the correlation between low ADL and mortality remains unclear. We assessed the levels of ADL and effects of rehabilitation in hemodialysis patients with low ADL. Moreover, the association between the baseline functional independence measure (FIM) or rehabilitation treatment effects and all-cause mortality were investigated. Methods: This prospective cohort study included 182 inpatients on maintenance hemodialysis, who underwent rehabilitation for a decline in ADL. Before and after initiating rehabilitation, ADL were assessed using FIM. Results: The total baseline FIM was 65.1 26.9 (motor items: 39.5 18.7; cognitive items: 25.6 10.7). After rehabilitation, the total FIM increased to 77.1 33.1 (motor items: 50.9 24.4; cognitive items: 26.1 10.8). The baseline FIM, presence or absence of FIM increase, and albumin were significantly associated with mortality. Moreover, the mortality hazard ratio in patients with FIM ! 67 and no FIM increase was 20-fold significantly higher than that in patients with FIM " 68 and FIM increase. The cognitive items and albumin were significantly associated with the rehabilitation effects in multivariate analysis. Conclusions: Although the FIM decreased by half in hemodialysis patients, rehabilitation improved their FIM (particularly the motor items). The FIM was a novel predictive marker of 3-year mortality in these patients, and an increased FIM after rehabilitation resulted in better prognosis. Moreover, the effectiveness of rehabilitation may depend on maintaining cognitive functions.

Evidence supporting the use of a subjective staff evaluation to assess the benefit of rehabilitation in hemodialysis patients undergoing inpatient rehabilitation

“…Consistent with this expectation, recent studies show the magnitude of improvement with rehabilitation, in patients recently started onto dialysis, to be similar to that of non-dialysis patients [ 6 – 8 ]. The study population has similar characteristics to other studies of dialysis patients suggesting low risk of selection bias and that our findings may be widely generalizable [ 9 – 21 ]. For example, Forrest et al, reported that the median change in FIM scores, in 40 HD patients, with a mean age of 69 years, undergoing inpatient rehabilitation was similar to our population (a change from mean baseline scores of 80 to 104 by discharge) [ 11 ].…”

Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability

“…The identification of a correlation between ADL disability and PDF prevalence/severity opens a scenario of interventions that may ultimately improve PDF. In fact, functional impairment may be prevented, reversed or delayed in patients on chronic hemodialysis through an adequate rehabilitation . Various approaches have been proposed in hemodialysis patients such as environmental adaptations, psychosocial, physical and cognitive interventions, training and education and adaptive aids .…”

Association of blood pressure with mortality in hemodialysis patients with a tunneled cuffed catheter

“…[ 22 , 23 ] Although a prospective study reported that ADL is influenced by age, [ 22 ] the Barthel index was not correlated with age in our cohort (Spearman's rho = 0.574). This may indicate that improvement of ADL through rehabilitation may decrease mortality in this population as ADL, [ 23 ] unlike age, is a modifiable factor.…”