Intradialytic Yoga as a complex intervention for patients with end stage kidney disease receiving haemodialysis treatment : a mixed methods approach

Abstract

A diagnosis of end stage kidney disease is life threatening and over time, significantly reduces patient quality of life. To survive, patients require dialysis or a kidney transplant, and the majority receive haemodialysis. Patients experience a high burden of symptoms associated with multiple comorbidities and the side effects from treatment. Symptom relief is provided by pharmacological treatments however altogether these are not reliable for all patients. Low levels of physical activity are also correlated with symptom burden which is endemic among haemodialysis patients whose efforts to lead a normal life are impeded by poor health and treatment dependency. Thus, steps should be taken to provide workable and safe therapies for symptom burden, and a means to foster patient self-care. The central aim of this thesis was to: explore the acceptability, feasibility, perceived safety and efficacy of Yoga practice during haemodialysis; co-design an intradialytic Yoga protocol with input from patients and nephrology nurses; and to evaluate the potential effects of intradialytic Yoga on health outcomes. A mixed methods research approach was utilised to implement three sequential Stages of the thesis. Stage One systematically reviewed evidence that Yoga may have desirable effects for end stage kidney disease. Stage Two sought to understand the workability, perceived safety and effectiveness of intradialytic Yoga via three sub-studies. Quantitative, qualitative and mixed techniques were used (i.e. cross-sectional questionnaires and semi-structured interviews) to develop and refine relevant parameters of Yoga practice, in conjunction with clinical considerations for the delivery of intradialytic Yoga lessons. Finally, Stage Three involved testing the feasibility of delivering the intervention and its acceptability to patients. In conclusion, intradialytic Yoga was found to be workable and safe. For larger future randomised controlled trials, this thesis also provided evidence for the application of intradialytic Yoga as a therapy for symptom burden and self-care, pilot tested using biological and patient-centred outcomes.

Date of Award	2019
Original language	English