Effect Of Home Otago Exercise On Fall Efficacy In Elderly Maintenance Hemodialysis Patients

ObjectiveTo investigate the status of exercise and fall efficacy in elderly maintenance hemodialysis（MHD）patients and analyze the factors of exercise disorders.To construct Otago exercise scheme,and analyze the effects of Otago Exercise Program（OEP）on fall efficiency,physical activity,exercise self-efficacy and balance ability of elderly MHD patients.To provide reference for clinical nurses when giving exercise guidance to dialysis patients.Methods1.Current situation investigation:Using quantitative and qualitative research methods,180elderly MHD patients from blood purification centers of two tertiary hospitals in Kunshan City in December 2021 were selected by convenience sampling method for questionnaire survey on their exercise status.Meanwhile,17 MHD patients were selected for semi-structured interviews,the interview data were sorted out,the data were processed,analyzed and read repeatedly,valuable ideas were proposed,classified and coded,so as to further sublimate the subject content and analyze the barriers to exercise.2.Intervention study:Sixty elderly patients with MHD in the blood purification center of a third-class A hospital in Kunshan City were selected as the research objects.Since the dialysis time of hemodialysis patients was fixed within a week,the patients were divided into two groups according to the dialysis time,Group A:dialysis on Monday,Wednesday and Friday,group B:dialysis on Tuesday,Thursday and Saturday,group A and group B were randomly divided into intervention group and control group by random number table method.The control group received routine health education and exercise education,and the intervention group received routine health education and Otago exercise program,a total of 6 months of intervention.Revised fall efficacy scale,leisure time physical activity questionnaire,exercise self-efficacy scale and berg balance scale were collected before intervention,3 months after intervention and6 months after intervention,and the data were statistically analyzed.Results1.Results of current investigation（1）A total of 180 valid questionnaires were collected.The highest,lowest and median metabolites of physical activity in leisure time were 1188MET-min/w,0MET-min/w,and396MET-min/w.The median score of Exercise Self-efficacy Scale（ESE）M=3.44,P₂₅=2.33,P₇₅=5.11;The score of the Modified Fall Efficacy Scale（MFES）was（66.97±16.31）,including indoor efficacy（45.20±11.29）points and outdoor efficacy（21.77±6.47）points.The score of Berg Balance Scale（BBS）was（38.03±3.21）.By Spearman correlation test,the fall efficacy level of elderly MHD patients was positively correlated with leisure time physical activity,exercise self-efficacy and balance function.（2）The exercise psychology of 17 elderly MHD patients was analyzed,and a total of 3related topics and 9 subtopics were extracted.Theme 1:Lack of sports knowledge.（1）Single mode of movement.（2）The benefits of exercise are not clear.（3）Lack of information channels.Theme 2:Low self-efficacy.（1）Contradiction between exercise willingness and disorder.（2）Family caregiver and patient roles conflict.（3）Lack of willpower.（4）Psychological depression.Theme 3:Inadequate Family and Social environment Resources.（1）Lack of family and peer support.（2）Restrictions on social environmental resources.2.Results of intervention researchA total of 55 patients were studied.Among the 30 patients in the control group,2 patients withdrew from the study due to changes in their disease conditions.In the experimental group,2patients were excluded from the study due to insufficient time and 1 patient was unwilling to insist.Finally,28 patients were in the control group and 27 patients in the experimental group.The results show that:The results showed that there were significant differences in the intergroup effect,time effect and interaction effect of MFES score,LTPA score,ESE score and BBS score between two groups after intervention（P<0.05）.Conclusion1.The elderly patients with maintenance hemodialysis generally lack the ideal state of exercise,and the obstacles to exercise include lack of exercise knowledge,low sense of self-efficacy and limited family and social environment resources.2.Home Otago exercise intervention program can effectively enhance the elderly MHD fall efficacy level,physical activity,exercise self-efficacy level,improve the balance ability of patients,and the intervention effect is better than conventional intervention.