Evaluating Acceptability Domain Of An Intradialytic Exercise Program-Patient Adherence And Nursing Documentation
Bibliographic record
Abstract
For patients with end stage renal disease, exercise during hemodialysis (HD), intradialytic exercise (IDE), may mitigate treatment related symptoms including cramping, restless legs, and fatigue. In Alberta Kidney Care North, IDE is supervised by a clinical exercise physiologist (CEP) and dialysis unit staff assist with program delivery. PURPOSE: The aim of this study was to examine program responsiveness to the patients' needs (acceptability) by evaluating documentation of patient adherence. METHODS: 1,752 exercise sessions were audited at 6 hemodialysis units. Patient reported participation was collected directly from patients within 10 days of the audit. Baseline and subsequent physical reassessments were examined to verify the validity of patient recall, relative to the required exercise dose. Data points were divided into 2 categories: active IDE participants(A-IDE) and non-active IDE(NA-IDE) participants. A-IDE were defined as patients who completed at least 1 IDE session/week for 4 weeks. NA-IDE participants were defined as those previously assessed and programmed but recently discharged, on a medical hold, or participating in a home exercise program at the time of the audit. RESULTS: Of the 1,332 A-IDE sessions audited, nurses documented patient participation 28.08%, no participation 49.4%, and did not document 22.52%. Patients reported adherence 63.74%. Physical reassessment data showed improved outcome measures thereby, validating patient recall of adherence. Of 420 NA-IDE HD data sheet analyzed, nurses documented patient participation 1.9%, no participation 70.24%, and did not document 27.85%. Patient report and documentation agreed 2.7%. CONCLUSIONS: Assessment of IDE participation is an integral component to the evaluation of an IDE program. Discrepancies between patient report and documented adherence exist. We found that patient report is valid, based on improved measures at reassessments; however, we must establish feasible methods for dialysis staff to collect adherence when CEPs are not present. Staff training, including regular surveys to assess staff knowledge of processes, may provide valuable information on units with a high staff turnover. Implementing an IDE prescription confirmation, as a standard practice in HD treatment preparation, may affirm participation.
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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 | 0.010 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".