| ObjectiveThis project aims to constructing a scientific and applicable intradialytic exercising program for maintenance hemodialysis patients,providing a standardized and scientific process of intradialytic exercising intervention for the care of MHD patients.At the same time,the effects of this program on dialysis sufficiency,exercise ability,inflammatory indicators and quality of life in MHD patients were also discussed.Methods1.Uptodate,Best Practice,JBI Evidence-Based Health Care Center Database,GIN International Guide Library,China Guide Network,Pub Med,Embase,Web of Science,Cochrane library,CNKI,Wan Fang Data,VIP Database were retrieved.To evaluate the quality of literature screening and extract the intervention measures,which can be used to provide evidence support for the development of exercising program.2.Through the Delphi expert letter consultation method,experts were invited to evaluate the exercise program and modify and supplement the program content to increase the practicability,scientificity and feasibility of the program,so as to make it more consistent with clinical practice and facilitate the implementation of nursing staff in work.3.A quasi-experiment study design was adopted to divide 67 patients who received MHD treatment in a blood purification center of a tertiary general hospital in Jiangsu Province from January to June 2020 into the experimental group(34 cases)and the control group(33 cases).The control group was given routine care during dialysis,and the experimental group was given care according to the intradialytic exercising program.Data were collected before intervention and 6 months after intervention,including Kt/V,exercise ability and inflammatory indicators.Patients’ quality of life was evaluated by SF-36 health survey,and then the effect of this exercise program on MHD patients was explored.Results1.Formulation of exercising program(1)Through searching related databases,a total of 2204 articles were retrieved.According to the inclusion and exclusion criteria,30 articles were finally screened out.Among them,8 articles used resistance exercise intervention during dialysis,and 10 articles used aerobic exercise intervention during dialysis.There are 7 documents adopting joint exercise intervention during dialysis,9 documents propose the establishment of a multidisciplinary team to formulate prescriptions and implementation interventions,6 documents propose monitoring during exercise and clarify the criteria for stopping exercise,and 17 documents introduce in the choice of exercise intensity,five articles mention the occurrence of adverse exercise reactions.The measures in the literature are summarized,including pre-exercise preparation,exercise prescription formulation,exercise monitoring,precautions and effect evaluation.(2)The effective recovery rate of the two rounds of expert letter questioning papers is 100%,the expert authority is 0.84 and 0.86 respectively,and the Kendall’s W coefficients are 0.376 and 0.412 respectively.Summarizing and modifying according to the results of the inquiry,an intradialytic exercising program for MHD patients with 4 first-level items,15 second-level items and 40 third-level items was finally formed.2.Application of exercising programAfter the intervention,5 cases were lost in the experimental group and 3 cases in the control group,and a total of 59 patients completed data collection.(1)There was no statistically significant difference in Kt/V between two groups before the intervention(P>0.05).After the intervention,the Kt/V of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.05).(2)There was no statistical difference in 6MWT and 30s-STS between two groups before the intervention(P>0.05),but the 6MWT and 30s-STS in the experimental group were higher than those in the control group after intervention,with statistical significance(P<0.05).(3)Before the intervention,there was no statistical difference in the inflammatory indicators between the two groups(P>0.05).After the intervention,CRP and IL-6 in the test group were lower than those in the control group,with statistical significance(P<0.05).(4)There was no significant difference in the SF-36 quality of life scores between the two groups before intervention(P>0.05).Compared with the control group,the SF-36 quality of life scores in the experimental group were improved after intervention,and the differences in physical function,physiological function,general health and total physical health scores were statistically significant(P<0.05).Conclusions(1)The intradialytic exercising program for MHD patients constructed in this study has strong scientific feasibility and clinical practicability.(2)A clinical empirical study was conducted on the exercise program during dialysis for MHD patients,showing that exercise regimens in dialysis can improve dialysis adequacy and exercise ability,improve microinflammatory status,and improve physical health-related quality of life scores.(3)The exercise program developed in this study provides evidence-based procedures and norms of intradialytic exercising intervention for MHD patients,and also provides reference for the formulation of intradialytic exercising intervention program in the future. |
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