Intervention Movie Download in HD: A Stunning Cinematic Experience

While exercise training by HD patients is beneficial, barriers persist to optimizing engagement. Exercise programs remain rare. When they are implemented, they neglect home and community-based activities [11, 13], and the importance of the involvement of family caregivers to support and reinforce exercise [21]. Participation rates are variable, and follow-up exercise adherence and maintenance of improved health outcomes is poor. Thus, exercise has yet to be effectively and systematically incorporated into routine care, particularly amongst older patients [7, 22], leaving renal care misaligned with best practice. Qualitative research exploring this misalignment has identified the need for a shift in the culture of ESRD treatment towards a wellness perspective that includes expectations of exercise participation by older patients during and outside of dialysis treatment, and encouragement by health care practitioners and family caregivers [22]. Creating a HD treatment culture that makes exercise a priority [7] requires that exercise prescription, counseling, and assessment be understood as a part of routine patient care. This signals that exercise, like medications, nutritional monitoring, and fluid management is an expected part of treatment [7, 22, 23]. Staff-level barriers, which have been well identified [16, 22], must be overcome through education to provide training in exercise prescription, lessen fear of potential adverse events, and balance the prioritizing of medical treatment with wellness. Staff must also be educated on how best to provide verbal and non-verbal encouragement to exercise in order to allay patient concerns that staff perceive intradialytic exercise as onerous [23]. Since information about exercise is also a priority for family caregivers in order to alleviate caregiver distress [24], as well as to improve patient health outcomes [25], the neglect of family caregivers in exercise interventions [13, 25] must be redressed.

We describe the protocol for a study we developed to increase exercise participation by older HD patients that involves a drama-based educational intervention. Fit for Dialysis is a film based on focus group research with patients, family caregivers, and dialysis staff that identified barriers and facilitators regarding exercise participation and counseling [22]. The film is intended to help effect a shift in the treatment of ESRD towards the inclusion of exercise participation by older HD patients, and exercise encouragement by staff and family caregivers as an expectation of treatment. We will compare the film in addition to a 16-week exercise program implemented in one hospital, with a 16-week exercise-only program in another hospital.

Intervention movie download hd

Download Zip: https://tinurli.com/2vDTU9

Our study of Fit for Dialysis will generate a rich data set for understanding the nature and extent of the impact of the film, for whom it is effective (patients, family caregivers, health care practitioners) and why, and under what conditions. Our study will further facilitate understanding of the actual degree of adoption of exercise, the extent to which and the reasons why the adoption occurred as intended, and the factors important for replication [35]. Further, by using a two-site design, we will generate data that will inform the design of a Phase III, cluster-randomized controlled trial of this intervention.

A prospective 2-site parallel intervention trial using mixed qualitative and quantitative methods has been selected to facilitate in-depth exploration of whether and why Fit For Dialysis works (or fails) in a particular setting, and for whom, including the actual degree of adoption and the extent to which the adoption occurred as intended.

Hospital A is a dialysis unit serving 318 patients in an acute care hospital in urban central Canada. Hospital B is a dialysis unit serving 210 patients in an acute care hospital in urban central Canada. The two study settings have similar populations of patients and nurse staffing mix. Neither has an existing exercise program as part of their renal program. Both hospitals are fully supportive of this proposal. Both hospitals will receive the exercise program, and an independent researcher will select which of the two sites will receive Fit for Dialysis using the following random allocation rule: roll a single 6-sided die and allocate the active intervention site to Hospital A if the number on top of the die is even or to Hospital B if the number is odd [43].

The Two-Minute Walk Test (2MWT): The 2MWT measures speed and distance, providing information about functional exercise capacity. Participants are asked to walk as far as they can in 2 min. The assessor uses a digital stopwatch and a calibrated wheel with a counter to measure the distance walked in metres. Two practice walks will be performed before the actual walk test is recorded [46]. The 2MWT has been shown to be reliable and valid in frail older adults, and has been used with the HD population [19, 47]. The 2MWT is our primary physical fitness outcome measure, and will be administered at baseline, 8 and 16 weeks, and 12 weeks after the end of the intervention.

Grip Strength Test: The Grip Strength Test is a reliable and valid measure of upper extremity strength and is predictive of mortality and deteriorating health in older adults [50, 51]. Age-specific normative data have been published for grip strength [52]. Grip strength will be measured at baseline, 8 and 16 weeks, and 12 weeks after the end of the intervention in a standardized fashion three times in each arm (alternating between arms) using a Jamar Dynamometer [51]. Since vascular access (e.g. a fistula on the forearm) may interfere with strength testing, the location and type of vascular access will be noted each time the test is administered [53].

The Timed-Up-and-Go (TUG): The TUG is a test of basic mobility and reflects the ability to transfer from sitting to standing and to walk a short distance (3 m) and return to a seated position [54]. After a practice trial, the final two trials will be recorded and the best measure will be used for analysis [54]. Reliability and validity [55, 56] are well established. The TUG will be administered at baseline, 8 and 16 weeks, and 12 week after the end of the intervention.

Pedometer: Pedometers are a widely used method for inferring activity levels based on the number of steps taken throughout the day [63, 64] and considered the gold standard in physical activity measurement [65]. Patients will be asked to wear a pedometer for 1 week at baseline, and at the 8- and 16-week assessments, and 12 weeks after the end of the intervention (to facilitate comparison with the GLTEQ measured at those time points). The PTAs will download the data from the pedometer at each assessment point. Compliance with wearing a pedometer, and its validity as a measure of exercise have both been demonstrated in older adults with various chronic illnesses [64, 66].

Exercise Logs: During the 16-week intervention, an intradialytic exercise log will be kept by the PTAs documenting exercises performed by the patients, as well as perceived exertion and heart rate. Patients will also be asked to keep a log of the exercises performed at home and in the community. The PTAs will review the exercise logs with the patients prior to each intradialytic exercise session to discuss any concerns.

Adherence: Adherence is important to assess as it is a necessary step to achieve gains in physical fitness (which would, in turn, lead to broader health benefits). However, there is no gold standard for assessing adherence to exercise, particularly in an elderly dialysis population. We have based our exercise prescription and definition of adherence on clinical judgement and prior experience providing exercise to frail older HD patients [19]. Adherence is thus defined as meeting at least 70% of the exercise prescription (recognizing that the number of minutes of prescribed exercise per week may change during the protocol as patients improve their fitness level with exercise), on average, over the 16-week intervention [67]. Given the separate components of exercise (intradialytic and home/community-based) that are being targeted by our intervention, we will include both a global adherence measure and separate adherence measures for the two exercise components (intradialytic and home/community). This same definition of adherence will be used for the intradialytic exercise and home/community exercise components. In addition, a global dichotomous measure of adherence will be used to facilitate inclusion in a multivariable model in which patients will be considered adherent overall if they are adherent (at least 70% of the exercise prescription) to both intradialytic and home/community exercise components, and non-adherent otherwise.

Quantitative analysis of exercise prescription adherence (intradialytic and home/community exercise components) will be examined. To determine if patients are adherent to the intradialytic component, PTA-recorded minutes of intradialytic exercise performed each week will be compared to the prescription for that week (e.g. 50 min in week 3 were done, 60 min were prescribed, which is 83% adherent). Similarly, for the home/community component, adherence will be based on weekly number of minutes of exercise performed based on the GLTEQ results compared to the weekly exercise prescription. Multivariable logistic regression for each adherence variable will be performed at 8 weeks (mid-intervention), 16 weeks (end of intervention), and 12 weeks post-intervention including hospital as the main predictor. Covariates including age and sex will be included in the model based on clinical judgment guided by our prior work [19] and the literature.

The results highlight that adaptation of the intervention helped reach the target population and improved participant attendance, but might have compromised fidelity to original design, as intervention components were shortened and modified for rural delivery and some facilitators made ad hoc modifications. The screenings coverage and frequency were adequate; however, their duration was shortened due to COVID-19 restrictions in Senegal. Participant responsiveness was excellent, as was the series appropriateness for most topics, including GBV. SRH remains a sensitive topic for youth, especially when the film clubs included non-peers, such as slightly older women. 2ff7e9595c