Abstract
Background : Hemodialysis (HD) patients are likely to perceive difficulties in performing lower-limb-related activities of daily living (ADL) due to decreased motor function and the presence of comorbidities. In our previous study, a novel questionnaire evaluating perceived difficulty in performing ADL related to lower limb function (HD-PDADL) was developed for patients undergoing HD therapy and its reliability and validity were assessed. Purpose : The present study assessed the responsiveness of the HD-PDADL to exercise training. Methods : After a 6-month observation period, 11 ambulatory HD patients (mean age, 63±9 years) without dementia completed a 3-month home-based exercise training program. We serially measured clinical characteristics, motor function and lower-limb-related ADL at the start of the observation period, and immedately before and after the 3-month exercise training. Motor function measures included leg strength, functional reach and maximal walking speed. Lower-limb-related ADL was evaluated using the functional independence measure (FIM) and the HD-PDADL. For HD-PDADL, patients were asked to grade the perceived difficulty of 12 items on a scale of 1 (inability) to 5 (no difficulty). Changes in leg strength, functional reach, maximal walking speed and FIM and HD-PDADL scores during the observation period and exercise training were analyzed successively using analysis of variance, and standardized response means (SRMs) were calculated to examine the responsiveness of FIM and HD-PDADL. Results : Following exercise training, leg strength and HD-PDADL score significantly increased (p<0.05, respectively), but other motor function measures and FIM score did not show any significant changes. Moreover, there was a correlation between changes in HD-PDADL score and leg strength during exercise training (p<0.05). SRMs of FIM and HD-PDADL during exercise training were 0.45 and 1.17, respectively. Conclusion : These findings suggest that HD-PDADL is highly responsive to exercise training in HD patients.
