title: A randomized controlled trial to evaluate the effectiveness of a cognitive behavioural group approach to improve patient adherence to peritoneal dialysis fluid restrictions: a pilot study.
abstract: BACKGROUND
  Peritoneal dialysis (PD) requires patients to take an active role in their adherence to fluid restrictions. Although fluid non-adherence had been identified among this patient group, no specific interventions have been researched or published with in the PD population. The current study sought to investigate whether an applied cognitive behavioural therapy (CBT-based intervention) used among haemodialysis patients would improve fluid adherence among PD patients; utilizing clinical indicators used in practice.
  
  
  METHODS
  Fifteen PD patients identified as fluid non-adherent were randomly assigned to an intervention group (IG) or a deferred-entry control group (CG). The study ran for a total of 21 weeks, with five data collection points; at baseline, post-intervention and at three follow-up points; providing a RCT phase and a combined longitudinal analysis phase. The content of the group intervention encompassed educational, cognitive and behavioural components, aimed to assist patients' self-management of fluid.
  
  
  RESULTS
  No significant differences in weight (kg) reduction were found in either phase and undesirable changes in blood pressure (BP) were observed. However, in the longitudinal phase, a statistically significant difference in oedematous status was observed at 6-week follow-up; which may be indicative of fluid adherence. Positive and significant differences were observed in the desired direction for measures of psychological well-being, quality of life and health beliefs; areas correlated with enhanced fluid adherence in other research.
  
  
  CONCLUSIONS
  This study reveals encouraging and significant changes in predictors of fluid adherence. Although there were no significant changes in weight as a crude clinical measure of fluid intake, significant reductions in oedematous status were observed as a consequence of this CBT-based group intervention.
authors.affiliation: Centre for Health Psychology, Staffordshire University and the Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hare
authors.forename: David
authors.initials: D
authors.lastname: Clark-Carter
authors.forename: Mark
authors.initials: M
authors.lastname: Forshaw
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D004327:Drinking Behavior; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010530:Peritoneal Dialysis; D010865:Pilot Projects; D011615:Psychotherapy, Group; D011788:Quality of Life; D012648:Self Care; D016896:Treatment Outcome
keywords: CBT; fluid adherence; peritoneal dialysis; psychological intervention; randomized controlled trial