Fluctuating nature of mobility limitations causes distress for patients on dialysis
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Findings from a study that assessed mobility in patients on hemodialysis found related limitations, frequently severe, presented emotional challenges that were amplified by the varying nature of the condition.
“As outlined in the International Classification of Functioning, Disability, and Health (ICF) framework from the [WHO], mobility is fundamentally shaped by three types of factors: health, environment, and personal,” Christine K. Liu, MD, MS, of Boston University School of Medicine and Stanford University School of Medicine, and colleagues wrote. “Broadly, personal factors describe individual-level influences on mobility. While personal factors include well-defined demographic characteristics, the category also includes more variable attributes such coping style and social support. Yet data on the impact of personal factors on the mobility of older persons undergoing [hemodialysis] HD are sparse, hindering the development of solutions to comprehensively address mobility limitations in older adults receiving HD. Our research objective was to identify important personal factors impacting the mobility of older adults receiving HD using a qualitative approach.”
The study consisted of a single home visit to 31 adults aged 60 years and older who received HD. Mobility was assessed using the short physical performance battery (SPPB) and a one-on-one interview with the patients. According to the researchers, the purpose of the SPPB was to assess balance, gait speed and lower extremity function among the patients on HD. Of the patients assessed in the study, 61% scored 0 on the SPPB chair stand domain, while 32% scored 0 on the balance domain.
Across the study group, many similarities emerged between the themes extracted from different patients’ experiences regarding the potential link between HD and mobility.
“Multiple participants described how their mobility changed, sometimes on a daily basis,” Liu and colleagues wrote. “Two participants, who had SPPB scores of 4 and 6 points, cited the effects of HD treatment on their mobility, describing how their mobility worsened after HD treatments. Others described how acute illness often made mobility worse. Another subtheme was the perception of mobility as a fragile and precarious state that could change at any moment.”
According to the researchers, mobility should be considered when practicing and developing HD care, because its effect on patient emotional stability is significant.
The study also found that while demographic factors contribute to patient mobility levels, coping style and social support are also an influence, meaning that adaptability and sources of encouragement are key to treating mobility issues in patients on HD.
“We found older adults receiving hemodialysis did poorly on a mobility assessment, with scores that predict 20% 1-year mortality in other patient populations,” Liu told Healio Nephrology. “They feel that their mobility often waxes and wanes, and these frequent changes are often hard to predict and difficult to cope with. While their mobility is emotionally frustrating, older adult receiving hemodialysis have learned to take an adaptable approach to their troubles with walking and often have sources of support within their lives to help cope with the mobility changes.
But this still doesn’t change the fact that folks often have trouble just being able to do daily tasks, such as getting dressed. As clinicians, losses in mobility are not on our radar, and we are doing a disservice to these folks by not addressing it more,” Liu said.
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