A nurse-led case management program on home exercise training for hemodialysis patients: A randomized controlled trial

BackgroundPatients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients.ObjectivesThe purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients.DesignThe study was a randomized, two-parallel group trial.SettingsHemodialysis units in two tertiary hospitals in Nanjing, mainland China.ParticipantsOne hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n = 57) or the control group (n = 56).MethodsBoth groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program.ResultsThe results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111) = 4.42, p = 0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03) centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111) = 3.93, p = 0.050]. The study group showed a mean improvement of 11.08 (±3.32) cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111) = 3.92, p = 0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88) s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group.ConclusionsHome exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients.