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A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

ABSTRACT: Background:Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education (EME) is a fatigue management approach that teaches people to use practical strategies (eg, prioritizing, using efficient body postures, organizing home environments) to manage their energy expenditure during everyday life. Objective:The aim of this study is to explore whether EME is associated with improvements in fatigue and life participation in adults on chronic dialysis. Design:Five single-case interrupted time-series AB studies, and follow-up qualitative interviews. Setting:The hemodialysis and peritoneal dialysis units at an academic hospital in Toronto, Canada. Patients:In total, 5 patients on chronic dialysis therapy were purposively selected to represent diversity in age, gender, and modality. Measurements:Brief questionnaires assessing fatigue and life participation were administered weekly during the baseline and intervention periods. Additional validated questionnaires (the Fatigue Impact Scale, 36-Item Short-Form Health Survey [SF-36] Vitality Scale, and Canadian Occupational Performance Measure) were also administered at baseline and post-intervention. Methods:All participants underwent "The PEP Program," a personalized, web-supported EME program designed to meet the needs of people on dialysis. During the program, participants complete 2 brief web modules about energy management, and then use energy management principles and a problem-solving framework to work on 3 life participation goals during sessions with a trained program administrator. Data were analyzed using visual analysis and the Tau-U statistic for the weekly time-series data, and thematic analysis for the qualitative interviews. Results:Three of 5 participants displayed a consistently positive response to the Personal Energy Planning (PEP) program across multiple measures of fatigue and life participation. Tau-U effect size estimates ranged from small to moderate, according to the time-series data. All 5 participants expressed that the program had benefited them in qualitative follow-up interviews, with the most common reported benefit being that the program made day-to-day activities easier. The format of the program was also said to be feasible and convenient. Limitations:An exploratory, proof-of-concept study that used a small set of participants and lacked an active control comparison. Conclusions:The PEP program might have potential for improving fatigue-related outcomes in people on chronic dialysis. Larger, controlled studies of the program are warranted.

SUBMITTER: Farragher JF

PROVIDER: S-EPMC7163233 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

Farragher Janine F JF Polatajko Helene J HJ McEwen Sara S Jassal Sarbjit V SV

Canadian journal of kidney health and disease 20200416

<h4>Background</h4>Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education (EME) is a fatigue management approach that teaches people to use practical strategies (eg, prioritizing, using efficient body postures, organizing home environments) to manage their energy expenditure during everyday life.<h4>Objective</h4>The aim of this study is to explore whether EME is associated with improvements in fatigue ...[more]

PMID: 32328286

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Project description:BackgroundEstimation of glomerular filtration rate (GFR) using estimated glomerular filtration rate creatinine (eGFRcr) is central to clinical practice but has limitations. We tested the hypothesis that serum metabolomic profiling can identify novel markers that in combination can provide more accurate GFR estimates.MethodsWe performed a cross-sectional study of 200 African American Study of Kidney Disease and Hypertension (AASK) and 265 Multi-Ethnic Study of Atherosclerosis (MESA) participants with measured GFR (mGFR). Untargeted gas chromatography/dual mass spectrometry- and liquid chromatography/dual mass spectrometry-based quantification was followed by the development of targeted assays for 15 metabolites. On the log scale, GFR was estimated from single- and multiple-metabolite panels and compared with eGFR using the Chronic Kidney Disease Epidemiology equations with creatinine and/or cystatin C using established metrics, including the proportion of errors >30% of mGFR (1-P30), before and after bias correction.ResultsOf untargeted metabolites in the AASK and MESA, 283 of 780 (36%) and 387 of 1447 (27%), respectively, were significantly correlated (P ≤ 0.001) with mGFR. A targeted metabolite panel eGFR developed in the AASK and validated in the MESA was more accurate (1-P30 3.7 and 1.9%, respectively) than eGFRcr [11.2 and 18.5%, respectively (P < 0.001 for both)] and estimating GFR using cystatin C (eGFRcys) [10.6% (P = 0.02) and 9.1% (P < 0.05), respectively] but was not consistently better than eGFR using both creatinine and cystatin C [3.7% (P > 0.05) and 9.1% (P < 0.05), respectively]. A panel excluding creatinine and demographics still performed well [1-P30 6.4% (P = 0.11) and 3.4% (P < 0.001) in the AASK and MESA] versus eGFRcr.ConclusionsMultimetabolite panels can enable accurate GFR estimation. Metabolomic equations, preferably excluding creatinine and demographic characteristics, should be tested for robustness and generalizability as a potential confirmatory test when eGFRcr is unreliable.

Project description:BackgroundClinical tests for detecting central and peripheral shoulder fatigue are limited. The discrimination of these two types of fatigue is necessary to better adapt recovery intervention. The Kinematic Theory of Rapid Human Movements describes the neuromotor impulse response using lognormal functions and has many applications in pathology detection. The ideal motor control is modeled and a change in the neuromuscular system is reflected in parameters extracted according to this theory.ObjectiveThe objective of this study was to assess whether a shoulder neuromuscular fatigue could be detected through parameters describing the theory, if there is the possibility to discriminate central from peripheral fatigue, and which handwriting test gives the most relevant information on fatigue.MethodsTwenty healthy participants performed two sessions of fast stroke handwriting on a tablet, before and after a shoulder fatigue. The fatigue was in internal rotation for one session and in external rotation during the other session. The drawings consisted of simple strokes, triangles, horizontal, and vertical oscillations. Parameters of these strokes were extracted according to the Sigma-Lognormal model of the Kinematic Theory. The evolution of each participant was analyzed through a U-Mann-Whitney test for individual comparisons. A Hotelling's T 2-test and a U-Mann-Whitney test were also performed on all participants to assess the group evolution after fatigue. Moreover, a correlation among parameters was calculated through Spearman coefficients to assess intrinsic parameters properties of each handwriting test.ResultsCentral and peripheral parameters were statistically different before and after fatigue with a possibility to discriminate them. Participants had various responses to fatigue. However, when considering the group, parameters related to the motor program execution showed significant increase in the handwriting tests after shoulder fatigue. The test of simple strokes permits to know more specifically where the fatigue comes from, whereas the oscillations tests were the most sensitive to fatigue.ConclusionThe results of this study suggest that the Sigma-Lognormal model of the Kinematic Theory is an innovative approach for fatigue detection with discrimination between the central and peripheral systems. Overall, there is a possibility to implement the setting for clinics and sports personalized follow-up.

Dataset Information

A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

Publications

A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

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