title: A nurse-led case management program on home exercise training for hemodialysis patients: A randomized controlled trial.
abstract: BACKGROUND
  Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients.
  
  
  OBJECTIVE
  The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients.
  
  
  METHODS
  The study was a randomized, two-parallel group trial.
  
  
  METHODS
  Hemodialysis units in two tertiary hospitals in Nanjing, mainland China.
  
  
  METHODS
  One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n=57) or the control group (n=56).
  
  
  METHODS
  Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program.
  
  
  RESULTS
  The results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111)=4.42, p=0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03)centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111)=3.93, p=0.050]. The study group showed a mean improvement of 11.08 (±3.32)cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111)=3.92, p=0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88)s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group.
  
  
  CONCLUSIONS
  Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Xingjuan
authors.initials: X
authors.lastname: Tao
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. Electronic address: susan.chow@polyu.edu.hk.
authors.forename: Susan Ka Yee
authors.initials: SK
authors.lastname: Chow
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Frances Kam Yuet
authors.initials: FK
authors.lastname: Wong
mesh_terms: D019090:Case Management; D002681:China; D015444:Exercise; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D009740:Nursing Staff; D006435:Renal Dialysis
keywords: Functional status; Hemodialysis; Home exercise; Physical activity; Quality of life