Determining the Feasibility of the Cardiac Rehabilitation Paradigm and its Impact on Exercise Self-Efficacy Among Chronic Kidney Disease Patients: a Pilot Study
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Date
2015-09-09
Authors
Pyka, Kasha
Keyword
Self-Efficacy , Recruitment , Cardiac Rehabilitation , Chronic Kidney Disease
Abstract
Background: Patients with chronic kidney disease (CKD) are in the “highest risk” group for cardiovascular disease (CVD) and nephrology guidelines recommend referral to cardiac rehabilitation (CR) to prevent its development. However, there is limited evidence supporting this recommendation and as few as 10% of patients with CKD utilize this service. In the general population, CR has been shown to enhance cardiovascular (CV) health and exercise self-efficacy (SE). Among persons with CKD, evidence suggests that CR may be an effective tool to improve CV health; however, no studies regarding its impact on exercise SE have been conducted. Given the low utilization of this service among patients with CKD, it is necessary to determine accrual and retention rates to inform the potential for a larger systematic trial. The primary goals of our study were to: (a) determine recruitment and enrollment ratios of patients with CKD to CR; and (b) examine changes in exercise SE across their participation in a CR program.
Methods: A retrospective chart review was undertaken at the Nephrology Program at Kingston General Hospital. Charts were screened for demographic information and clinical descriptors. Eligible participants were offered enrollment in a 16-week CR program; where exercise SE, CVD risk factors, self-management behaviours, and physical function outcomes were measured. Results: A total of 611 charts were reviewed. Of those eligible for inclusion, 7 individuals were recruited to the study (recruitment ratio = 4.6%); however, only 3 were retained for enrollment (enrollment ratio = 2.0%). The lack of physician endorsement and travel distance may have contributed to the low enrollment. Across the course of their participation in CR, exercise SE was observed to change by +12.8%, -5.3%, and +11.5% from baseline to discharge for each participant, respectively.
Conclusions: This is the first study to: (a) quantify the feasibility of recruiting and enrolling persons with CKD in CR and (b) describe monthly changes in exercise SE via a case series. Evidence supports the hypothesis that CR is a potentially powerful agent to improve exercise SE among patients with CKD; however, further work is needed to elucidate barriers and facilitators to CR enrollment, and the relationship between exercise SE and participation in this health service. Methods: A retrospective chart review was undertaken at the Nephrology Program at Kingston General Hospital. Charts were screened for demographic information and clinical descriptors. Eligible participants were offered enrollment in a 16-week CR program; where exercise SE, CVD risk factors, self-management behaviours, and physical function outcomes were measured. Results: A total of 611 charts were reviewed. Of those eligible for inclusion, 7 individuals were recruited to the study (recruitment ratio = 4.6%); however, only 3 were retained for enrollment (enrollment ratio = 2.0%). The lack of physician endorsement and travel distance may have contributed to the low enrollment. Across the course of their participation in CR, exercise SE was observed to change by +12.8%, -5.3%, and +11.5% from baseline to discharge for each participant, respectively.
Conclusions: This is the first study to: (a) quantify the feasibility of recruiting and enrolling persons with CKD in CR and (b) describe monthly changes in exercise SE via a case series. Evidence supports the hypothesis that CR is a potentially powerful agent to improve exercise SE among patients with CKD; however, further work is needed to elucidate barriers and facilitators to CR enrollment, and the relationship between exercise SE and participation in this health service.