Data from: Patient and staff perceptions of intradialytic exercise before and after implementation: a qualitative study

Introduction: Despite guidance and evidence for the beneficial effects of intradialytic exercise (IDE), such programmes are rarely adopted within practice and little is known about how they may best be sustained. The Theoretical Domains Framework (TDF) was used to guide the understanding of the barriers and facilitators to initial and ongoing IDE participation and to understand how these are influential at each stage. Materials and Methods: Focus groups explored patient (n=24) and staff (n=9) perceptions of IDE prior to the introduction of a programme and, six months later, face to face semi-structured interviews captured exercising patients (n=11) and staffs’ (n=8) actual experiences. Data were collected at private and NHS haemodialysis units within the UK. All data were audio-recorded, translated where necessary, transcribed verbatim and subject to framework analysis. Results: IDE initiation can be facilitated by addressing the pre-existing beliefs about IDE through the influence of peers (for patients) and training (for staff). Participation was sustained through the observation of positive outcomes and through social influences such as teamwork and collaboration. Despite this, environment and resource limitations remained the greatest barrier perceived by both groups. Conclusions: Novel methods of staff training and patient education should enhance engagement. Programmes that clearly highlight the benefits of IDE should be more successful in the longer term. The barrier of staff workload needs to be addressed through specific guidance that includes recommendations on staffing levels, roles, training and skill mix.引言：尽管已有指南与证据证实透析间期运动（intradialytic exercise, IDE）具有临床获益效果，但此类运动方案在临床实践中极少被采纳，且目前对如何最优地维持该方案的持续实施仍缺乏深入认知。本研究采用理论领域框架（Theoretical Domains Framework, TDF），旨在解析影响患者初始参与及持续开展透析间期运动的阻碍因素与促进因素，并阐明这些因素在不同实施阶段的作用机制。 材料与方法：在透析间期运动方案正式引入前，本研究通过焦点小组访谈调研了24名患者与9名医护人员对IDE的认知情况；方案实施6个月后，通过面对面半结构化访谈收集了11名参与运动的患者及8名医护人员的实际体验数据。数据采集于英国境内的私立及英国国民保健服务（NHS）血液透析中心。所有数据均进行录音，必要时进行翻译，随后逐字转录并采用框架分析法开展数据分析。 结果：针对患者群体，可借助同伴影响纠正其对IDE的固有认知；针对医护人员，则可通过培训实现这一目标，从而推动IDE的启动实施。而通过观察到的积极获益效果，以及团队协作等社会影响因素，可维持参与者的运动依从性。尽管如此，环境与资源限制仍是两组人群共同认为的最主要实施阻碍。 结论：研发新型医护人员培训与患者教育方法，有助于提升参与者的参与积极性。清晰阐明IDE获益效果的运动方案，在长期实施中可取得更佳效果。医护人员工作负荷这一阻碍因素，需通过制定包含人员配置水平、岗位职责、培训内容及技能组合建议的专项指南来加以解决。