Increasing the uptake of exercise programs in the dialysis unit: a protocol for a realist synthesis
Bibliographic record
Abstract
BACKGROUND: For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment (intradialytic exercise) may promote exercise adherence and enhance aspects of the dialysis treatment. However, intradialytic exercise programs are complex and how to adapt program components to local context so that the program is more likely to attain its intended health outcomes have not been well described. To increase the uptake of exercise in clinical practice, more evidence is needed on how contextual factors influence the program's impact. METHODS: Using the realist approach, we aim to understand how the processes and structures of intradialytic exercise programs work to influence patient participation according to different contextual factors. The focus of a realist review is explanatory and aims to develop and test theory on how contextual factors trigger specific processes or behaviors (or "mechanisms") to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, we will use a range of sources to develop initial candidate theories: a scoping review of published papers and the gray literature, and discussion with stakeholders. To provide a theoretical basis for how contextual factors could work to influence patient participation in intradialytic exercise (IDE), several of our preliminary theories will be based on dominant theories of exercise adherence and behavior change. To support or refute these initial theories, we will synthesize data from a systematic literature review and semi-structured interviews with intradialytic exercise program stakeholders, sampled from a range of programs worldwide. DISCUSSION: The complexity of intradialytic exercise programs poses challenges to their implementation. Using the "context, mechanism, outcome" approach, the knowledge gained from this study will be used to develop general recommendations for renal care providers and administration on how to adapt components of an intradialytic exercise programs according to different contextual factors in order to promote patient participation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033335.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.139 | 0.219 |
| Meta-epidemiology (narrow) | 0.006 | 0.004 |
| Meta-epidemiology (broad) | 0.011 | 0.013 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.008 | 0.007 |
| Scholarly communication | 0.009 | 0.007 |
| Open science | 0.006 | 0.008 |
| Research integrity | 0.010 | 0.013 |
| Insufficient payload (model declined to judge) | 0.075 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".