Identifying Goals and Barriers to Exercise for Prehabilitation in Older Adults awaiting Kidney Transplantation and their Caregivers

确定等待肾移植的老年人及其护理人员进行康复训练的目标和障碍

• 批准号: 10250506
• 负责人: Anoop Sheshadri
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10250506
• 关键词: Address; Adherence; Adult; Age-Years; Aging; Caregiver Burden; Caregiver support; Caregivers; Caring; Clinical Trials; Consensus; Data; Development; Dialysis patients; Dialysis procedure; Disease; Dyspnea; Elderly; End stage renal failure; Enrollment; Equilibrium; Exercise; Fatigue; Fellowship; Focus Groups; Foundations; Future; Geriatrics; Goals; Group Interviews; Health Promotion; Heart failure; Impairment; Individual; Intervention; Interview; K-Series Research Career Programs; Kidney Transplantation; Lower Extremity; Lung diseases; Mentors; Mentorship; Mission; National Institute on Aging; Nephrology; Operative Surgical Procedures; Organ; Outcome; Participant; Patient Recruitments; Patients; Personal Satisfaction; Physical Function; Physical Performance; Physical activity; Physiological; Play; Polypharmacy; Population; Premature aging syndrome; Procedures; Process; Public Health; Qualitative Research; Quality of life; Randomized Controlled Trials; Recovery; Reporting; Research; Research Methodology; Risk; Role; Structure; System; Testing; Time; Training; Transplant Recipients; Transplantation; Transplanted Kidney Complication; United States; United States National Institutes of Health; Voice; Waiting Lists; Walking; Work; aged; care burden; career; cognitive interview; cohort; design; exercise adherence; exercise intervention; exercise program; expectation; experience; fear of falling; frailty; functional disability; functional loss; functional status; high risk; improved; improved functioning; individual patient; intervention effect; mortality; older patient; preference; recruit; screening; walking intervention

PROJECT SUMMARY: End-stage renal disease (ESRD) is a disease of premature aging and is associated with impairments in functional status and quality of life. The dialysis population is growing older each year, and older patients with ESRD are at very high risk for functional impairment. Kidney transplantation (KT) is a well- established therapy that has the potential to ameliorate the detrimental effects of ESRD on physical activity, quality of life, and functional status. However, KT alone may not meet the full extent of this potential, particularly for older or more impaired adults. In fact, physical activity declines immediately post-KT and fails to return to expected levels even up to 5 years post-KT. Older patients waitlisted for KT (most of whom are on dialysis) are therefore reliant on their pre-KT levels of exercise, which are also predictive of post-KT mortality. “Prehabilitation” has recently emerged as a strategy in other surgical populations to enhance recovery and minimize functional loss, and a structured exercise program may be beneficial in the pre-KT population. However, though exercise interventions have been successful in improving physical function and quality of life among patients with ESRD, only a small percentage of waitlisted patients may actually be able to participate in such interventions. Patients treated with dialysis in general have barriers such as severe fatigue, dyspnea, and lack of time or exercise partners. Older patients have additional barriers such as further impairments in mobility, fear of falling, and effects of polypharmacy. In addition, many older dialysis patients require caregiver support for transport and for adherence to such interventions. Therefore older patients are likely to have unique barriers to exercise interventions, and may also have specific goals for such an intervention. For an exercise intervention to be successful in this setting, it is necessary to conduct formal qualitative research that includes the voices of older adults awaiting KT as well the voices of their caregivers. The major goal of this study is to use qualitative research methodology to formally evaluate facilitators of and barriers to an exercise intervention for prehabilitation in older patients awaiting KT. We will perform one- on-one cognitive interviews of 30 older adults and 30 of their caregivers in paired dyads. We expect to elicit unmet needs of older patients awaiting KT and goals that may not be fully addressed by the procedure. We will then conduct semi-structured focus group interviews recruited from the cohort of patients and caregivers who have previously been interviewed to establish a consensus on prehabilitation, including details of a possible future intervention such as expected outcomes and specifics of coaching. Primary mentorship will be provided by Rebecca Sudore, MD (Geriatrics, Qualitative Research). Additional mentors are Jennifer C. Lai (Frailty in End-Organ Disease, Transplantation) and Kirsten Johansen (Exercise in ESRD). This study will provide valuable data on patient and caregiver experience of KT and potential prehabilitation and will serve as the foundation for future studies iterating, optimizing, and ultimately piloting the intervention in clinical trials.

项目摘要：终末期肾病(ESRD)是一种过早衰老的疾病，与 功能状态和生活质量受损。透析人口一年比一年老龄化，而且 老年ESRD患者发生功能损害的风险非常高。肾移植(KT)是一种很好的 已建立的治疗方法有可能改善终末期肾病对体力活动的有害影响， 生活质量和功能状态。然而，仅靠KT可能不能完全满足这种潜力， 尤其是对于年长或身体更虚弱的成年人。事实上，KT后体力活动立即下降，并未能 即使在KT后长达5年的时间内，也能恢复到预期水平。年龄较大的患者正在等待KT(他们中的大多数都在 因此，透析患者依赖于KT前的运动水平，这也是KT后死亡率的预测指标。 “康复训练”最近已成为其他外科手术人群促进康复的一种策略。 并将功能损失降至最低，在KT前人群中，有组织的锻炼计划可能是有益的。 然而，尽管运动干预在改善身体机能和生活质量方面取得了成功 在终末期肾病患者中，只有一小部分等待名单的患者实际上可能能够参与 这样的干预。接受透析治疗的患者一般都有障碍，如严重的疲劳、呼吸困难和 缺乏时间或锻炼伙伴。老年患者有额外的障碍，如进一步的障碍 机动性，对跌倒的恐惧，以及多药联用的影响。此外，许多老年透析患者需要照顾者 支持运输和遵守此类干预措施。因此，老年患者很可能有独特的 运动干预的障碍，也可能对这种干预有具体的目标。为了一次练习 为了在这种情况下取得成功，有必要进行正式的定性研究，包括 等待KT的老年人的声音以及他们的照顾者的声音。 本研究的主要目的是使用定性研究方法来正式评估促进者。 运动干预对等待KT的老年患者康复的影响和障碍。我们将表演一场- 对30名老年人和他们的30名照顾者进行了一对一的认知访谈。我们希望能引出 等待KT的老年患者的未得到满足的需求和该程序可能无法完全解决的目标。我们会 然后进行半结构化焦点小组访谈，从符合以下条件的患者和护理人员队列中招募 曾接受约谈，以就康复问题达成共识，包括可能的细节 未来的干预措施，如预期结果和教练的具体情况。将提供主要的指导 作者：丽贝卡·苏多尔，医学博士(老年病学，定性研究)。其他导师是Jennifer C.Lai(Frailty In 终末器官疾病，移植)和Kirsten Johansen(在ESRD中锻炼)。这项研究将提供 关于患者和照顾者关于KT和潜在康复的经验的宝贵数据，将作为 为未来的研究迭代、优化并最终在临床试验中试行干预奠定基础。