N LI1, M DA SILVA-GANE2, A CASS3, K PATTERSON4, A YIP1, W HANDKE5, AC WEBSTER6,7, RL MORTON1
1NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia, 2Department of Renal Medicine, Lister Hospital, Stevenage, UK, 3Menzies School of Health Research, Casuarina, Australia, 4Health Economics Research Centre, The University of Oxford, Headington, UK, 5Home Dialysis Advisory Committee, Kidney Health Australia, Canberra, Australia, 6Sydney School of Public Health, The University of Sydney, Sydney, Australia, 7Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney at Westmead, Westmead, Australia
Aim: To evaluate the effectiveness of interventions aimed to maintain or increase employment for adults on dialysis.
Background: Kidney patients and carers have prioritised interventions to maintain employment in their top five research concerns, however it remains unclear which interventions are effective.
Methods: A Cochrane systematic review was undertaken (protocol no 333). Databases searched included MEDLINE, CENTRAL, EMBASE, CINAHL, PsychINFO, ClinicalTrials.gov and kidney-related journals from 1980-2018, to determine the effect of interventions on the maintenance or improvement of employment (full or part-time). Risk of bias in the primary studies was systematically assessed by two reviewers, with the quality of evidence for each intervention category assessed using the GRADE approach.
Results: Nineteen studies (three RCTs 251 participants, 16 non-RCTs 104,697 participants) were included from 1679 identified articles, describing dialysis modality, drug, physical exercise, psychosocial or government policy interventions. Physical exercise on non-dialysis days increased employment status at four years compared with baseline, in one RCT (6.3% increase, p<0.05). Independent daily exercise with counselling, compared with usual care, did not improve self-reported work status in a second RCT. For peritoneal dialysis patients admitted to a renal ward, structured post-discharge telephone sessions (psychosocial intervention) improved work status, compared with usual care in another RCT (p=0.02). However, all RCTs presented low quality evidence. Very low-quality evidence from five non-RCTs suggested peritoneal dialysis might not improve work retention compared with facility haemodialysis (RR=1.07 [0.94-1.22]). Employer-group health insurance was positively associated with employment retention (N=2), however retention was not improved in patients accessing Medicare/ Medicaid/ disability payments (N=2).
Conclusions: Low quality evidence suggests adults starting chronic dialysis may benefit from physical exercise and psychosocial interventions to maintain or improve employment status.
Nina Li is currently completing a Bachelor of Science (Medicine) Hons/ Doctor of Medicine. She has a keen interest in renal medicine.