Mr Richard S Modderman2,4, Ms Onika Paolucci3, Ms Sara Zabeen4, Ms Clee Tonkin2, Dr Anne Marie Eades5, Ms Deborah Roe10, Ms Rebecca Jarman3, Ms Kerry Dole3, Ms Gwen Lowah3, Mr Emidio Cocetti6, Ms Anne Weldon7, Ms Jacqueline Kent7, Ms Kirsty Annesley7, Mr Mattias Jing7, Ms Margaret Purnell8, Mr Tolbert Gaykamangu9, Mr Wayne Alum9, Ms Edna Wittkopp9, Mrs Anne-Marie Puruntatemeri9, Prof. Jaquelyne Hughes1,3,4
1College Of Medicine And Public Health, Flinders University (NT), Darwin, Australia, 2Physiotherapy Department, Royal Darwin and Palmerston Hospital, Darwin, Australia, 3Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, 0810, 4Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia, 5School of Allied Health, Curtin University, Perth, Australia, 6Business Systems, Royal Darwin Hospital , Darwin, Australia, 7Financial Modelling and Analysis, Royal Darwin Hospital, Darwin, Australia, 8Health Services Libraries, Royal Darwin Hospital, Darwin, Australia, 9Live Strong Patient Reference Group, Menzies School of Health Research, Darwin, Australia, 10Top End Health Service Occupational Therapy, Darwin, Australia
Background
Access to home dialysis is important to remote Australians living with chronic kidney disease, which may be enabled by strategies that reduce frailty.
Aim
To develop and pilot a population-specific physical frailty assessment, provided alongside physiotherapy restorative care for adults commencing dialysis in Northern Australia.
Methods
Patient-experts recommended the Medical Research Council dyspnoea scale, hand grip strength, de Morton Mobility Index and the one-minute sit-to-stand test, as feasible measures to detect patient-relevant physical function for adults after starting dialysis. Incorporated in a physical frailty assessment (PFA), they were administered at baseline and 16 weeks, during a six month period (March- September 2021), by a physiotherapist within the New Start Dialysis Transition Program. Optional restorative care and individualised physical function goal setting was also offered.
Results
Baseline assessments were completed in 20 adults (mean age 53.55±14.35 years, 80% Indigenous, 80% haemodialysis). All identified physical function goals, with 100% desiring walking improvement. Median dyspnoea scale and de Morton Mobility Index were 3 (1,4) and 74 (67, 96.3). Mean hand grip strength and one-minute sit-to-stands were 23.2±9.1kg and 13.8±10.7 repetitions, respectively. Ten participants completed follow-up, with 70% goal achievement recorded, and improvements in hand grip strength (p=0.03), de Morton Mobility Index (p=0.04) and one-minute sit-to-stands (p=0.02).
Conclusion
We show patient-endorsed PFA measures detected physical frailty among adults after starting dialysis. Furthermore, attainment of physical function goals and objective PFA measures were observed within a Physiotherapy-led restorative care program embedded within multidisciplinary renal care. Associations of improved physical function achieved within this program and accessibility to home dialysis, and transplant waitlisting is planned.
Biography:
Richard Modderman is a senior Physiotherapist with clinical interests in chronic disease management and musculoskeletal health. This abstract builds on our previous scoping review of published literature which identified absence of clinical frailty assessment tools developed with and used by First Nations adults with advanced chronic kidney disease. Nested within the New Start Dialysis Transition program, and within COVID-pandemic preparation and response phase locally, our goal was to assist clients to avoid unplanned hospital admissions, Live Strong, COVID-safe and Frailty-Free after Starting Dialysis. This work was funded by APPRISE Ramsay First Nations COVID19 research grants and Top End Health Service.