R MODDERMAN 1,2, O PAOLUCCI 3, C TONKIN 1, S ZABEEN 2, J HUGHES 2,3
1Department of Physiotherapy, Royal Darwin Hospital, Darwin, Australia, 2Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia, 3Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
Aim: To describe the development of a Physiotherapist supervised frailty screening tool for Aboriginal and Torres Strait Islander adults with chronic kidney disease (CKD).
Background: Frailty among Aboriginal and Torres Strait Islander people who require dialysis restricts accessibility of home-dialysis. A population specific frailty detection tool could aid referrals to restorative care interventions and improve patient physical functioning and quality of life.
Methods: A scoping review described frailty detection measures, using three population-specific eligibility criteria (Aboriginal and Torres Strait lslander people, adult, CKD), and measurements of frailty. This data informed the consultation stage about population and context-specific needs.
Results:An online search of Medline, CINAHL and Embase databases in February and May 2021 identified 157 contemporary studies describing [adult + chronic kidney disease + frailty measures], yet no studies involved Aboriginal and Torres Strait Islander people. Consultations occurred via meetings, in-services and electronic correspondence, and interviews with patient references, multidisciplinary clinical staff and an Aboriginal health practitioner (AHP). They recommended that a frailty detection tool should incorporate non-deficit framing, practicality, efficiency (time, space) and must identify both high and low levels of physical function. Therefore, we confirmed 4 measurements (1. MRC dyspnoea scale, 2. Hand-grip strength, 3. 1-minute sit-to-stand test (fitness) and 4. deMorton mobility index), developed a context-specific frailty assessment procedure, and a patient-approved resource.
Conclusion:We know that patient-important outcomes include living strong and accessing dialysis on country. This locally developed frailty tool will improve identification of patients who may benefit from restorative care interventions. A 6-month pilot of the frailty screening tool may inform context-specific resourcing to support patient physical functioning and promote home dialysis accessibility, including dialysis on country.
‘Richard is a Physiotherapist working for Top End Health Service at Royal Darwin Hospital in the Northern Territory. He has an interest in the role of exercise and physical activity for the management of kidney disease. In 2021 he has been leading a pilot of a culturally safe outpatient renal Physiotherapy service, supported by Menzies School of Health Research.