Physiotherapy-led restorative care enabling improved frailty measures in adults after starting dialysis in Northern Territory of Australia: The ‘Frailty-to-Fit’ pilot study

Abstract

Purpose

Aboriginal and Torres Strait Islander peoples’ culture is integral to health and wellbeing; this includes access to traditional Country, maintenance of kinship relationships, to speak traditional language and participate in cultural practices. Most clients commencing dialysis in remote Australia, including the Northern Australia region, identify as Aboriginal and/or Torres Strait Islander peoples. Aboriginal people who need kidney replacement therapy and are physically fit to access home dialysis report additional health and cultural benefits beyond achieved dialysis adequacy. This study aimed, within the setting of local COVID-19 pandemic preparations and response phases, to design and pilot a physical frailty assessment tool to inform the support needs of physically frail adults in the Northern Territory of Australia after starting haemodialysis.

Methods

Informed by a literature review and patient advisors, the tool incorporated patient-important domains of dyspnoea, strength, mobility and fitness using the Medical Research Council dyspnoea scale, hand grip strength, de Morton Mobility Index and 1-minute sit-to-stand test. During April to September 2021, frailty measures were recorded at baseline and 16 weeks at one outpatient location, alongside optional restorative care and individualised physical function goal setting. Data were presented as median (IQR) and percentage.

Main findings

Twenty adults completed the baseline assessment: median age was 51 (47, 67) years, 80% were Aboriginal and/or Torres Strait Islander peoples, 80% were utilising haemodialysis and 53 (35, 74) days after incident dialysis. All study participants identified physical function goals, including walking improvement. Baseline measures for the dyspnoea scale and de Morton Mobility Index were 3 (1, 4) and 74 (67, 96); hand grip strength was 21.1 (21.1, 27.4) kg, and 1-minute sit-to-stand repetitions was 16.0 (3.3, 21.0), respectively. Ten patients returned for follow-up measures, with a 70% goal achievement and statistically significantly improved measures for hand grip strength (P = 0.03), de Morton Mobility Index (P = 0.04) and 1-minute sit-to-stand (P = 0.02).

Principal conclusions

Baseline physical frailty and subsequent personal physical goal attainment were associated with improvements in strength, fitness and mobility in adults after starting dialysis.