Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment

• Published in: PloS one 2018-04, Vol.13 (4), p.e0196313-e0196313
• Main Authors: Regolisti, Giuseppe, Maggiore, Umberto, Sabatino, Alice, Gandolfini, Ilaria, Pioli, Sarah, Torino, Claudia, Aucella, Filippo, Cupisti, Adamasco, Pistolesi, Valentina, Capitanini, Alessandro, Caloro, Giorgia, Gregorini, Mariacristina, Battaglia, Yuri, Mandreoli, Marcora, Dani, Lucia, Mosconi, Giovanni, Bellizzi, Vincenzo, Di Iorio, Biagio Raffaele, Conti, Paolo, Fiaccadori, Enrico
• Format: Article
• Language: English
• Subjects: Attitudes; Behavior; Beliefs, opinions and attitudes; Biology and Life Sciences; Care and treatment; Clinical trials; Confidence intervals; Consent; Dialysis; Employees; Exercise; Feet; Fitness training programs; Health care; Health risks; Hemodialysis; Hemodialysis patients; Kidney diseases; Medical personnel; Medicine and Health Sciences; Mortality; Mortality risk; Pancreas; Patients; Physical activity; Physical fitness; Physical training; Physiological aspects; Quality of life; Risk factors; Sedentary behavior; Systematic review; Ulcers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0196313

In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff's attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population. In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff's attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff's attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile-Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers. Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 ["Feeling too old", 95% Confidence Interval: -9.4 to -0.8] and -15.6 ["Ulcers on legs and feet", 95%CI: -24.8 to -6.5]. We found a significant interaction between staff's attitude and barriers (adjusted P values ranging between 0.03 ["I do not believe that it is physician's or nurse's role providing advice on exercise to patients on dialysis"] and 0.001 ["I do not often ask patients about exercise"]). A beneficial effect of a proactive staff's attitude was evident only in patients not endorsing barriers. Barriers and non-proactive staff's attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff's attitude.