Increasing the uptake of exercise programs in the dialysis unit: a protocol for a realist synthesis.

Stephanie Thompson,Marcello Tonelli,Scott Klarenbach,Anita Molzahn,Alex Clark

doi:10.1186/s13643-016-0224-6

Stephanie Thompson, Marcello Tonelli + Show 3 more

Open Access

https://doi.org/10.1186/s13643-016-0224-6

Copy DOI

Abstract

BackgroundFor people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment (intradialytic exercise) may promote exercise adherence and enhance aspects of the dialysis treatment. However, intradialytic exercise programs are complex and how to adapt program components to local context so that the program is more likely to attain its intended health outcomes have not been well described. To increase the uptake of exercise in clinical practice, more evidence is needed on how contextual factors influence the program’s impact.MethodsUsing the realist approach, we aim to understand how the processes and structures of intradialytic exercise programs work to influence patient participation according to different contextual factors. The focus of a realist review is explanatory and aims to develop and test theory on how contextual factors trigger specific processes or behaviors (or “mechanisms”) to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, we will use a range of sources to develop initial candidate theories: a scoping review of published papers and the gray literature, and discussion with stakeholders. To provide a theoretical basis for how contextual factors could work to influence patient participation in intradialytic exercise (IDE), several of our preliminary theories will be based on dominant theories of exercise adherence and behavior change. To support or refute these initial theories, we will synthesize data from a systematic literature review and semi-structured interviews with intradialytic exercise program stakeholders, sampled from a range of programs worldwide.DiscussionThe complexity of intradialytic exercise programs poses challenges to their implementation. Using the “context, mechanism, outcome” approach, the knowledge gained from this study will be used to develop general recommendations for renal care providers and administration on how to adapt components of an intradialytic exercise programs according to different contextual factors in order to promote patient participation.Systematic review registrationPROSPERO CRD42016033335Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0224-6) contains supplementary material, which is available to authorized users.

Highlights

For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment may promote exercise adherence and enhance aspects of the dialysis treatment
Systematic reviews of interventions using regular exercise training suggest that exercise is a promising means of improving these outcomes in people with Chronic kidney disease (CKD): regular exercise is associated with improvements
Several proposed explanations for the low uptake of intradialytic exercise (IDE) programs in clinical practice are as follows: the unknown effects of exercise on “hard” outcomes, such as survival [12]; the uncertainty on what exercise to recommend to patients for optimal benefit; and the methodological limitations of existing exercise randomized controlled trial (RCTs) the lack of blinded outcome assessment [3]

Summary

Introduction

For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment (intradialytic exercise) may promote exercise adherence and enhance aspects of the dialysis treatment. Several proposed explanations for the low uptake of IDE programs in clinical practice are as follows: the unknown effects of exercise on “hard” outcomes, such as survival [12]; the uncertainty on what exercise to recommend to patients for optimal benefit; and the methodological limitations of existing exercise randomized controlled trial (RCTs) the lack of blinded outcome assessment [3] Even if these questions on efficacy are addressed, there is still a largely unaddressed evidence-practice gap about how to adapt the components of IDE programs to different contexts so that the program achieves its goals. A better understanding of the processes and structures that are necessary for the program to attain its effects can inform site-specific adaptation and potentially enhance program effectiveness [13]

Objectives

Methods

Conclusion