A Study Of Application On Dry Weight Management Based On IMB Model For The Patients In Young And Middle-aged With Maintenance Hemodialysis

Objectives To introduced the information-motivation-behavioral skills(IMB)model theory into the implementation of dry weight management in patients with maintenance hemodialysis(MHD).And to constructed a dry weight management program for patients with MHD based on the IMB model combined with the characteristics of middle-aged patients with MHD.To explore the effect of dry weight management based on the IMB model on the Interdialysis weight control,self-management and symptom burden of dialysis patients in young and middle-aged MHD patients.To compare the application of the dry weight management scheme based on the IMB model with the routine daily management and health education programs of hemodialysis center,in order to lay a theoretical and practical basis for dry weight management of young and middle-aged patients with MHD.Methods This research used a randomized controlled trial design.Before the formal study,the literature review method and the focus group interview method were jointly designed to form a dry weight management program based on the IMB model,and the research team was set up to conduct pre-test to confirm the sample content.In the formal clinical study,It has been admitted to the young and middle-aged patients who were diagnosed with end-stage renal disease(ESRD)and were undergoing MHD according to the standard at one of the top three hospitals in Chengdu,Sichuan Province during the same period.A total of 80 patients were randomly divided into control group and experimental group according to the random number table with 40 cases in each group.The control group were implemented the routine daily management of the dry weight and routine health education.The subjects of the experimental group were implemented the dry weight management program based on the IMB model,including health education and individualized daily management based on the IMB model.The intervention time of both groups was 3 months.Among them,collective health education and individualized health education in each group are alternated,in which collective health education lectures are held every 4 weeks,and individual health education is conducted every two weeks.The routine daily management of the control group is only for dialysis day management,and the individualized daily management of the experimental group includes dialysis interval management.The amount of IDWG,the compliance rate of IDWG,Hemodialysis Self-Management Instrument(HD-SMI),and the Dialysis Frequency,Severity,and Symptom Burden Index(DFSSBI)were used before and after the intervention to evaluate the control status of dialysis interval weight,self-management behavior,and disease symptom burden of patients with MHD.Results A total of 75 subjects were included in the research.Among of them,37 cases were in the control group(1 case was removed and 2 cases were excluded),and 38 cases were in the experimental group(1 case was removed and 1 case was excluded).The results of the research are as follows: 1.The results of weight control during dialysis interval evaluation(1)The results of comparison before and after intervention in the same group For the control group,the amount of IDWG was lower than that before the intervention,and the compliance rate of IDWG after intervention was higher than that before the intervention,and the differences were statistically significant(P<0.05).For the experimental group,the amount of IDWG was lower than that before the intervention,and the compliance rate of IDWG after intervention was higher than that before the intervention,and the differences were statistically significant(P<0.05).(2)The results of comparison between groups After the intervention,the Interdialysis weight gain(IDWG)in the experimental group were lower than those of the control group,the compliance rate of IDWG in the experimental group were higher than that of the control group,and the differences were statistically significant(P<0.05).2.The results of Self-management behavior evaluation(1)The results of comparison before and after intervention in the same group For the control group,the total scores of HD-SMI and the scores of each dimension after intervention were higher than those before the intervention,and differences were statistically significant(P<0.05).For the experimental group,the total scores of HD-SMI and the scores of each dimension after intervention were higher than those before the intervention,and the differences were statistically significant(P<0.05).(2)The results of comparison between groups After the intervention,the total scores of HD-SMI and the scores of problem solving,self-care ability and emotional treatment in the experimental group were higher than those of the control group,and differences were was statistically significant(P<0.05).But,the score of the partnership dimension after the intervention in the experimental group was slightly higher than that of the control group,and the difference was not statistically significant(P>0.05).3.The results of Symptom burden evaluation(1)The results of comparison before and after intervention in the same group For the control group,the total scores of DFSSBI,the scores of frequency of occurrence,severity,degree of distress and the number of symptoms after intervention were lower than those before the intervention,and the differences were statistically significant(P<0.05).For the experimental group,the total scores of DFSSBI,the scores of frequency of occurrence,severity,degree of distress and number of symptoms after intervention were lower than those before the intervention,and the differences were statistically significant(P<0.05).(2)The results of comparison between groups After the intervention,the total scores of DFSSBI,the scores of frequency of occurrence,severity,degree of distress and the number of symptoms in the experimental group were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusions 1.The dry weight management based on the information-motivation-behavioral skills model can control effectively the Interdialysis weight of young and middle-aged patients with MHD,reduce the weight gain during dialysis interval,and improve the personal compliance rate of dialysis interval weight gain.2.The dry weight management based on information-motivation-behavioral skills model can strengthen effectively self-management behaviors of young and middle-aged patients with MHD.3.The dry weight management based on information-motivation-behavioral skills model can improve effectively the symptom burdens of young and middle-aged MHD patients.