A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: A randomized controlled trial
A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: A randomized controlled trial
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DOI：
10.1053/j.ajkd.2005.02.032
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发表时间：
2005-06-01
影响因子：
13.2
通讯作者：
Deighan, CJ
中科院分区：
文献类型：
--
作者：
Sharp, J;Wild, MR;Deighan, CJ
背景坚持液体限制是血液透析治疗方案中最困难的方面之一。本报告描述了一项基于小组的认知行为干预的随机对照试验，旨在改善接受血液透析患者的液体限制依从性。据推测，干预措施将改善依从性，通过透析间期体重增加（IWG）来衡量，而不会对心理社会功能产生负面影响。方法五十六例来自4个肾脏病门诊接受血液透析的患者被随机分为立即治疗组（ITG; n = 29）和延迟治疗组（DTG; n = 27）。参与者在基线，治疗后和随访阶段进行评估。治疗包括为期4周的干预，使用教育，认知和行为策略，以提高有效的自我管理的液体消耗。结果：急性期ITG和DTG的IWG均值差异无统计学意义（F-1，F-54 = 0.03; P > 0.05）。然而，在纵向分析中，平均IWG有显著的主效应（F-1.76，F-96.80 = 9-10; P < 0.001），基线和随访IWG值之间有显著差异（t（55）= 3.85; P < 0.001），反映了随着时间的推移依从性的改善。通过心理社会功能的测量，没有显示治疗的不良影响。一些显着的变化，证明在认知被认为是重要的调解行为的变化。结论：目前的研究提供了证据的可行性和有效性，应用基于群体的认知行为疗法，以提高遵守血液透析液体限制。结果进行了讨论的背景下，研究的方法的局限性。(c)2005年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background. Adhering to fluid restrictions represents one of the most difficult aspects of the hemodialysis treatment regimen. This report describes a randomized controlled trial of a group-based cognitive behavioral intervention aimed at improving fluid-restriction adherence in patients receiving hemodialysis. It was hypothesized that the intervention would improve adherence, measured by means of interdialytic weight gain (IWG), without impacting negatively on psychosocial functioning. Methods Fifty-six participants receiving hemodialysis from 4 renal outpatient settings were randomly assigned to an immediate-treatment group (ITG; n = 29) or deferred-treatment group (DTG; n = 27). Participants were assessed at baseline, posttreatment, and follow-up stages. Treatment consisted of a 4-week intervention using educational, cognitive, and behavioral strategies to enhance effective self-management of fluid consumption. Results: No significant difference in mean IWGs was found between the ITG and DTG during the acute-phase analysis (F-1,F-54 = 0.03; P > 0.05). However in longitudinal analysis there was a significant main effect for mean IWG (F-1.76,F-96.80 = 9-10; P < 0.001) and a significant difference between baseline and follow-up IWG values (t(55) = 3.85; P < 0.001), reflecting improved adherence over time. No adverse effects of treatment were indicated through measures of psychosocial functioning. Some significant changes were evidenced in cognitions thought to be important in mediating behavioral change. Conclusion: The current study provides evidence for the feasibility and effectiveness of applying group-based cognitive behavior therapy to enhance adherence to hemodialysis fluid restrictions. Results are discussed in the context of the study's methodological limitations. (c) 2005 by the National Kidney Foundation, Inc.