Feasibility of a Rehab-Led Intradialytic Exercise Program in the Acute Care Setting

Background and Purpose: Patients with end-stage renal disease require hemodialysis (HD), often leading to prolonged sedentary periods and missed physical and occupational therapy sessions during hospitalizations. Intradialytic exercise (IDE) – incorporation of exercise programs during hemodialysis sessions – has been shown to improve dialysis adequacy, cardiovascular fitness, muscle strength, and quality of life in the outpatient setting. IDE is widely studied in outpatient care, however this paper introduces a novel acute program implemented at a large, urban, academic medical center. This program was designed to enhance patient access to therapy services during hospitalizations and to demonstrate the feasibility and safety of IDE in the acute care setting. Approach: The Define, Measure, Analyze, Improve, and Control (DMAIC) methodology was utilized to effectively implement IDE in the acute care setting. Quantitative data identified the clinical nursing units with the highest prevalence of patients on dialysis, which determined the pilot units selected for IDE. Clinical guidelines, exclusion criteria, and a competency specific to IDE were developed and utilized to train physical and occupational therapists to perform IDE. Outcomes: Implementing IDE decreased the percentage of missed therapy sessions by 15%. Discussion and Conclusion: This study demonstrates that IDE is feasible and safe in the acute care setting. It is largely based on evidence from the outpatient setting, which demonstrates the safety, feasibility and positive impact of IDE on patient outcomes. Utilizing a competency and clinical guidelines, specifically for IDE, paired with educational sessions and in-person observation is an effective way to train therapists to perform IDE. IDE reduces the number of missed therapy sessions, allowing patients on dialysis increased access to therapy services while hospitalized. There is an opportunity to evaluate the impact of IDE on patient-specific outcomes in the acute care setting in the future.