1
|
Rossi F, Botti S, Morri M, Asaftei S, Bertin D, Breggiè S, Casalaz R, Cervo M, Ciullini P, Coppo M, Cornelli A, Esposito M, Ferrarese M, Ghetti M, Longo L, Naretto G, Orsini N, Panzeri D, Pellegrini C, Peranzoni M, Perna A, Petit N, Picone F, Pittorru G, Raffa D, Recchiuti V, Rizzato L, Sarzana M, Sensi R, Fagioli F, Ricci F. The Italian Consensus Conference on the role of rehabilitation for children and adolescents with leukemia, central nervous system tumors, and bone cancer, part 2: general principles for the rehabilitation treatment of motor function impairments. Pediatr Hematol Oncol 2024; 41:346-366. [PMID: 38984654 DOI: 10.1080/08880018.2024.2353360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 07/11/2024]
Abstract
In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers.
Collapse
Affiliation(s)
- Francesca Rossi
- Rehabilitation Service, Public Health and Pediatric Sciences Department, A.O.U. Città della Salute e della Scienza - Regina Margherita Children's Hospital, Turin, Italy
| | - Stefano Botti
- Haematology Unit, Oncology and Advanced Technology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Mattia Morri
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Sebastian Asaftei
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza - Regina Margherita Children's Hospital, Turin, Italy
| | - Daniele Bertin
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza - Regina Margherita Children's Hospital, Turin, Italy
| | - Simona Breggiè
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Casalaz
- Paediatric Oncohematology, Unit Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Marta Cervo
- Functional Rehabilitation Unit, A.O.U. Meyer, Florence, Italy
| | - Paola Ciullini
- Functional Rehabilitation Unit, A.O.U. Meyer, Florence, Italy
| | - Monica Coppo
- Health Professions of Rehabilitation Sciences Masters Degree, Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Annalisa Cornelli
- Pediatric Oncology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Miriana Ferrarese
- Health Professions of Rehabilitation Sciences Masters Degree, Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Marina Ghetti
- Pediatric Hematology Department, A.O.U. Policlinico Umberto I-Rome, Rome, Italy
| | - Lucia Longo
- Health Professions of Rehabilitation Sciences Masters Degree, Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Gabriella Naretto
- Rehabilitation, Department of Pediatric Orthopedics Unit A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, Turin, Italy
| | - Nicoletta Orsini
- Physical Therapy and Rehabilitation Department, Children's Hospital Giannina Gaslini, Genoa, Italy
| | - Daniele Panzeri
- Neuro-oncological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Chiara Pellegrini
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Peranzoni
- Department of Physiotherapy, Hospital of Bolzano, Health Trust, Bolzano, Italy
| | - Antonella Perna
- Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital St. Orsola-Malpighi, Bologna, Italy
| | - Nadine Petit
- Pediatric Hematology Department, A.O.U. Policlinico Umberto I-Rome, Rome, Italy
| | - Fabiola Picone
- Functional Rehabilitation Unit, A.O.U. Meyer, Florence, Italy
| | - Gianna Pittorru
- Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital St. Orsola-Malpighi, Bologna, Italy
| | - Debora Raffa
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Veronica Recchiuti
- Physical Therapy Neuroscience Department and Functional Rehabilitation, Children's Hospital Bambino Gesù, Rome, Italy
| | - Lucia Rizzato
- Complex Operative Unit of Orthopaedic Rehabilitation, AO of Padua, Padua, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Sensi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franca Fagioli
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza - Regina Margherita Children's Hospital, Turin, Italy
| | - Federica Ricci
- Division of Child Neurology and Psychiatry A.O.U. Città della Salute e della Scienza, Regina Margherita Children's Hospital, Turin, Italy
| |
Collapse
|
2
|
Trần TB, Ambrens M, Nguyễn J, Coleman E, Gilanyi Y, Letton M, Pandit A, Lock L, Thom JM, Sen S, Lambert K, Arnold R. Preferences of people with chronic kidney disease regarding digital health interventions that promote healthy lifestyle: qualitative systematic review with meta-ethnography. BMJ Open 2024; 14:e082345. [PMID: 38802278 PMCID: PMC11131123 DOI: 10.1136/bmjopen-2023-082345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES Diet and physical activity are crucial for people with chronic kidney disease (CKD) to maintain good health. Digital health interventions can increase access to lifestyle services. However, consumers' perspectives are unclear, which may reduce the capacity to develop interventions that align with specific needs and preferences. Therefore, this review aims to synthesise the preferences of people with CKD regarding digital health interventions that promote healthy lifestyle. DESIGN Qualitative systematic review with meta-ethnography. DATA SOURCES Databases Scopus, CENTRAL, MEDLINE, CINAHL and SPORTDiscus were searched between 2000 and 2023. ELIGIBILITY CRITERIA Primary research papers that used qualitative exploration methods to explore the preferences of adults with CKD (≥18 years) regarding digital health interventions that promoted diet, physical activity or a combination of these health behaviours. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened title, abstract and full text. Discrepancies were resolved by a third reviewer. Consumers' quotes were extracted verbatim and synthesised into higher-order themes and subthemes. RESULTS Database search yielded 5761 records. One record was identified following communication with a primary author. 15 papers were included. These papers comprised 197 consumers (mean age 51.0±7.2), including 83 people with CKD 1-5; 61 kidney transplant recipients; 53 people on dialysis. Sex was reported in 182 people, including 53% male. Five themes were generated regarding consumers' preferences for digital lifestyle interventions. These included simple instruction and engaging design; individualised interventions; virtual communities of care; education and action plans; and timely reminders and automated behavioural monitoring. CONCLUSION Digital health interventions were considered an important mechanism to access lifestyle services. Consumers' preferences are important to ensure future interventions are tailored to specific needs and goals. Future research may consider applying the conceptual framework of consumers' preferences in this review to develop and evaluate the effect of a digital lifestyle intervention on health outcomes. PROSPERO REGISTRATION NUMBER CRD42023411511.
Collapse
Affiliation(s)
- Thái Bình Trần
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Meghan Ambrens
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Jennifer Nguyễn
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Eve Coleman
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Yannick Gilanyi
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Meg Letton
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Anurag Pandit
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Logan Lock
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Ria Arnold
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Curtis F, Burton JO, Butt A, Dhaliwal HK, Graham-Brown MM, Lightfoot CJ, Rawat R, Smith AC, Wilkinson TJ, March DS. Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review. PLoS One 2024; 19:e0297107. [PMID: 38266006 PMCID: PMC10807786 DOI: 10.1371/journal.pone.0297107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.
Collapse
Affiliation(s)
- Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - James O. Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ayesha Butt
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | | | - Matthew M.P. Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Courtney J. Lightfoot
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Rishika Rawat
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Alice C. Smith
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Thomas J. Wilkinson
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Daniel S. March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| |
Collapse
|
4
|
Barnett A, Catapan SDC, Jegatheesan DK, Conley MM, Keating SE, Mayr HL, Webb L, Brown RCC, Coombes JS, Macdonald GA, Isbel NM, Burton NW, Campbell KL, Hickman IJ, Kelly JT. Patients' acceptability of self-selected digital health services to support diet and exercise among people with complex chronic conditions: Mixed methods study. Digit Health 2024; 10:20552076241245278. [PMID: 38854917 PMCID: PMC11162125 DOI: 10.1177/20552076241245278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/19/2024] [Indexed: 06/11/2024] Open
Abstract
Objective The acceptability of being offered a choice from a suite of digital health service options to support optimal diet and exercise behaviors in adults with complex chronic conditions was evaluated. This study sought to understand many areas of acceptability including satisfaction, ease of use, usefulness and user appropriateness and perceived effectiveness. Methods This mixed-methods study was embedded within a randomized-controlled feasibility trial providing digital health services managing diet and exercise for adults from specialist kidney and liver disease clinics. Post study surveys and semistructured interviews were used to determine patients' acceptability of the trial interventions. Quantitative (surveys) and qualitative (surveys and interviews) results were merged using integrative analysis and mapped to each construct of the modified version of the Theoretical Framework of Acceptability. Results Seventeen interviews (intervention group) and 50 surveys (n = 24 intervention, n = 26 comparator) completed from a possible 67 participants were analyzed. In the intervention group, the survey results revealed high areas of acceptability for the digital health services including overall support received, ease of use, timely advice and feeling safe. The interviews also revealed high areas of acceptability including convenience, ability to adopt healthier behaviors and having regular interactions with health professionals. However, the interviews also revealed lower areas of acceptability as a result of absence of individualization, low digital literacy, and limitations from life circumstances. Conclusions Recipients of digital health services that supported diet and exercise interventions found these useful, effective, and safe. Individualized care, technical support and patient confidence remain important to improve the acceptability of digital health service interventions.
Collapse
Affiliation(s)
- Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Soraia de Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Dev K Jegatheesan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Centre for Mental Health, Griffith University Mount Gravatt, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Katrina L Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane QLD, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- ULTRA Team, The University of Queensland Clinical Trials Capability, Herston, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
5
|
Kelly JT, Jegatheesan DK, Dawson J, Barnett A, Khor BH, Chang AR, Carrero JJ, Campbell KL. Are Digital Health Technologies and Models of Nutrition Care the Future of Chronic Kidney Disease Management? J Ren Nutr 2023; 33:S80-S87. [PMID: 36965753 DOI: 10.1053/j.jrn.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/11/2022] [Accepted: 02/27/2023] [Indexed: 03/27/2023] Open
Abstract
People living with chronic kidney disease (CKD) require long-term support at varying levels of individualization, intensity, and frequency. Mobile and digital models of nutrition care can facilitate long-term behavior change, address nutrition issues proactively, reduce travel burden, and reach people without access to health care more easily. However, while traditional health delivery continues to be digitally disrupted, there are many barriers to address before mobile and digitally supported models of nutrition care can become business as usual in nephrology and nutrition care practice. This paper overviews the current evidence base concerning the past and present mobile and digital health programs to improve nutrition in CKD and highlights the novel future trends in this field. The way nutrition and dietetic care can be feasible, safe, and potentially effective when delivered using various digital and virtual technologies, including consultations, assessments, establishment of diagnoses, formulation of plans, and monitoring/reviewing clinical progress is discussed. Of the available evidence to date, these modalities appear to improve dietary sodium intake and diet quality, self-efficacy, interdialytic weight gain, and body weight. Many barriers exist to sustaining the continued and widespread adoption of digital and mobile health-supported nutrition care in CKD. These include patient-, clinician-, and health system-specific and are discussed in detail. Mobile and digital-supported models of nutrition care present an exciting opportunity to assist kidney dietitians deliver patient-centred nutrition care in CKD.
Collapse
Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Dev K Jegatheesan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Amandine Barnett
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Alex R Chang
- Center for Kidney Health Research, Geisinger Health, Danville, PA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
6
|
Zhang H, Wang H, Huang L, Bai Y, Zhang F. Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2023; 45:2255677. [PMID: 37724555 PMCID: PMC10512821 DOI: 10.1080/0886022x.2023.2255677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.
Collapse
Affiliation(s)
- Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Yan Bai
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| |
Collapse
|
7
|
Gibson CA, Gupta A, Naik A, Sullivan DK, Doshi M, Backes J, Harvey S, Lee J, Mount R, Valentine H, Shaffer K. Developing a Healthy Lifestyle Program for Recent Kidney Transplant Recipients. Prog Transplant 2023; 33:193-200. [PMID: 37469164 DOI: 10.1177/15269248231189878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Many kidney transplant recipients experience weight gain in the first year after transplantation. RESEARCH QUESTION The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain. DESIGN In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program. RESULTS Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake. CONCLUSION Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.
Collapse
Affiliation(s)
- Cheryl A Gibson
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jim Backes
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan Harvey
- Department of Health, Sports, and Exercise Sciences, University of Kansas, Robinson Center, Lawrence, KS, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Rebecca Mount
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather Valentine
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly Shaffer
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
8
|
Barchfeld DC, Vagi RK, Lüdtke K, Schieffer E, Güler F, Einecke G, Jäger B, de Zwaan M, Nöhre M. Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx). Front Psychiatry 2023; 14:1071705. [PMID: 37113542 PMCID: PMC10126341 DOI: 10.3389/fpsyt.2023.1071705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/03/2023] [Indexed: 04/29/2023] Open
Abstract
The obesity epidemic and its health consequences have not spared the population of kidney transplant (KTx) candidates and recipients. In addition, KTx recipients are susceptible to weight gain after transplantation. Overweight and obesity after KTx are strongly associated with adverse outcomes. Therefore, we designed a randomized controlled, mono-center study to specifically test the effectiveness of a primarily cognitive-behavioral approach supplemented by nutritional counseling for weight reduction following KTx as the intervention group (IG) in comparison to a brief self-guided intervention as control group (CG). The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00017226). Fifty-six KTx patients with a BMI from 27 to 40 kg/m2 were included in this study and randomized to the IG or CG. Main outcome was the number of participants achieving a 5% weight loss during the treatment phase. Additionally, participants were assessed 6 and 12 months after the end of the 6-month treatment phase. Participants significantly lost weight without group differences. 32.0% (n = 8) of the patients in the IG and 16.7% (n = 4) of the patients in the CG achieved a weight loss of 5% or more. Weight loss was largely maintained during follow-up. Retention and acceptance rate in the IG was high, with 25 (out of 28) patients completing all 12 sessions and one patient completing 11 sessions. Short-term, cognitive-behaviorally oriented weight loss treatment seems to be feasible and acceptable for patients after KTx who suffer from overweight or obesity. This clinical trial was ongoing at the onset of the COVID-19 pandemic which might have influenced study conduct and results. Clinical Trial Registration: https://clinicaltrials.gov/ DRKS-ID: DRKS00017226.
Collapse
Affiliation(s)
- Dana Coco Barchfeld
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ricarda-Katharina Vagi
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katrin Lüdtke
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Elisabeth Schieffer
- Department of Cardiology, Angiology and Critical Care Medicine, Philipps University, Marburg, Germany
- Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Faikah Güler
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Gunilla Einecke
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Burkard Jäger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
- *Correspondence: Mariel Nöhre,
| |
Collapse
|
9
|
Emsley C, Snell G, Paul E, Fuller L, Paraskeva M, Nyulasi I, King S. Can we HALT obesity following lung transplant? A Dietitian- and Physiotherapy-directed pilot intervention. Clin Transplant 2022; 36:e14763. [PMID: 35761751 DOI: 10.1111/ctr.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Unintentional weight gain, overweight and obesity following solid organ transplantation (SOT) are well-established and linked to morbidity and mortality risk factors. No interventional studies aimed at prevention have been undertaken among lung transplant (LTx) recipients. The combination of group education and telephone coaching is effective in the general population but is untested among SOT cohorts. METHODS A non-randomised, interventional pilot study was conducted among new LTx recipients. The control group received standard care. In addition to standard care, the intervention involved four group education and four individual, telephone coaching sessions over 12-months. Data collection occurred at 2 weeks, 3- and 12 months post-LTx. Measurements included weight, BMI, fat mass (FM), fat mass index (FMI), fat-free mass (FFM), fat-free mass index (FFMI), waist circumference (WC), visceral adipose tissue (VAT), nutrition knowledge, diet, physical activity, lipid profile, HbA1C , FEV1 , six-minute walk distance and patient satisfaction. RESULTS Fifteen LTx recipients were recruited into each group. One control participant died 120 days post-LTx, unrelated to the study. There were trends towards lower increases in weight (6.7±7.2kg vs 9.8±11.3kg), BMI (9.6% of baseline vs 13%), FM (19.7% vs 40%), FMI, VAT (7.1% vs 30.8%) and WC (5.5% vs 9.5%), and greater increases in FFM and FFMI (all p>0.05), among the intervention group by 12 months. The intervention was well-accepted by participants. CONCLUSION This feasible intervention demonstrated non-significant, but clinically meaningful, favourable weight and body composition trends among LTx recipients over 12 months compared to standard care. Australian New Zealand Clinical Trials Registry (ACTRN12619001606178) This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Christie Emsley
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Greg Snell
- Lung Transplant Service, The Alfred Hospital, Victoria, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Fuller
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.,Discipline of Food, Nutrition and Dietetics, LaTrobe University, Bundoora, Victoria, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Susannah King
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.,Discipline of Food, Nutrition and Dietetics, LaTrobe University, Bundoora, Victoria, Australia
| |
Collapse
|
10
|
Castle EM, Dijk G, Asgari E, Shah S, Phillips R, Greenwood J, Bramham K, Chilcot J, Greenwood SA. The Feasibility and User-Experience of a Digital Health Intervention Designed to Prevent Weight Gain in New Kidney Transplant Recipients-The ExeRTiOn2 Trial. Front Nutr 2022; 9:887580. [PMID: 35677553 PMCID: PMC9168981 DOI: 10.3389/fnut.2022.887580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Half of kidney transplant recipients (KTRs) gain more than 5% of their body weight in the first year following transplantation. KTRs have requested support with physical activity (PA) and weight gain prevention, but there is no routine care offered. There are few high-quality studies investigating the clinical value of diet, PA or combined interventions to prevent weight gain. The development and evaluation of theoretically informed complex-interventions to mitigate weight gain are warranted. The aims of this mixed-methods randomized controlled trial (RCT) were to explore the feasibility, acceptability and user-experience of a digital healthcare intervention (DHI) designed to prevent post-transplant weight gain, in preparation for a large multi-center trial. New KTRs (<3 months) with access to an internet compatible device were recruited from a London transplant center. The usual care (UC) group received standard dietary and PA advice. The intervention group (IG) received access to a 12-week DHI designed to prevent post-transplant weight gain. Primary feasibility outcomes included screening, recruitment, retention, adherence, safety and hospitalizations and engagement and experience with the DHI. Secondary outcomes (anthropometrics, bioimpedance, arterial stiffness, 6-minute walk distance and questionnaires) were measured at baseline, 3- and 12-months. 38 KTRs were screened, of which 32 (84.2%) were eligible, and of those 20 (62.5%) consented, with 17 participants (85%) completing baseline assessment (Median 49 years, 58.8% male, Median 62 days post-transplant). Participants were randomized using a computer-generated list (n = 9 IG, n = 8 UC). Retention at 12-months was 13 (76.4%) (n = 6 IG, n = 7 UC). All a priori progression criteria were achieved. There were no associated adverse events. Reflexive thematic analysis revealed four themes regarding trial participation and experience whilst using the DHI. Halting recruitment due to COVID-19 resulted in the recruitment of 40% of the target sample size. Mixed-methods data provided important insights for future trial design. A definitive RCT is warranted and welcomed by KTRs. Clinical Trial Registration www.clinicalTrials.gov, identifier: NCT03996551.
Collapse
Affiliation(s)
- Ellen M. Castle
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| | - Giulia Dijk
- Department of Nutrition and Dietetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elham Asgari
- Kidney Services Team, Guy's and St Thomas' NHS Foundation Trust London, London, United Kingdom
| | - Sapna Shah
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| | - Rachel Phillips
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, London, United Kingdom
| | - James Greenwood
- Victor Horsley Department of Neurosurgery, University College London Hospital, London, United Kingdom
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sharlene A. Greenwood
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| |
Collapse
|
11
|
Technologies during the Covid-19 pandemic: teleconsultation in care management for patients undergoing liver transplantation. Transplant Proc 2022; 54:1324-1328. [PMID: 35810015 PMCID: PMC9023345 DOI: 10.1016/j.transproceed.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/02/2022] [Accepted: 03/13/2022] [Indexed: 11/23/2022]
|
12
|
“You Can’t Manage What You Can’t Measure”: Perspectives of Transplant Recipients on Two Lifestyle Interventions for Weight Management. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous research suggests that effective lifestyle interventions for solid organ transplant (SOT) recipients must be tailored to address the unique life circumstances of this population. As few studies have investigated this design consideration, this study aimed to explore the perspectives and experiences of SOT recipients after completing a Group Lifestyle Balance™ [GLB]-based intervention incorporating either (a) standard population-based nutrition guidance or (b) nutrigenomics-based nutrition guidance. All active participants in the Nutrigenomics, Overweight/Obesity, and Weight Management-Transplant (NOW-Tx) pilot study were invited to participate. Data were collected through focus groups and individual interviews. Ninety-five percent (n = 18) of the NOW-Tx pilot study participants enrolled in the current study: 15 participated in 3 focus groups; 3 were interviewed individually. Three themes were common to both intervention groups: (1) the post-transplant experience; (2) beneficial program components; (3) suggestions for improvement. A unique theme was identified for the nutrigenomics-based intervention, comprising the sub-themes of intervention-specific advantages, challenges, and problem-solving. The readily available and adaptable GLB curriculum demonstrated both feasibility and acceptability and was aligned with participants’ needs and existing health self-management skills. The addition of nutrigenomics-based guidance to the GLB curriculum may enhance motivation for behaviour change in this patient population.
Collapse
|