Interaction of healthcare staff’s attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment

Background and aim of the study
In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.
Methods
In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.
Results
Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers.
Conclusions
Barriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.

### 研究背景与目的
血液透析（hemodialysis）患者的久坐行为是一类可潜在干预的死亡风险因素。本研究旨在探讨医护人员对运动的态度，与患者感知到的运动障碍之间的交互作用，及其对该人群身体活动水平的调控效应。

### 研究方法
本研究为前瞻性、横断面、多中心研究，于意大利16家血液透析中心招募了608名成年患者与330名医护人员。研究通过专用问卷分别评估了患者感知到的运动障碍，以及医护人员对运动的态度。本研究采用多层线性模型（multilevel linear models），分析运动障碍、医护人员态度及其交互作用与患者自我报告身体活动水平（人类活动概况-调整活动评分[Human Activity Profile–Adjusted Activity Score，简称HAP-AAS]）之间的关联，并校正了多项混杂因素。此外，本研究采用潜类别分析（latent class analysis）将患者划分为存在运动障碍与不存在运动障碍两类。

### 研究结果
多数运动障碍与HAP-AAS呈负相关，单一项运动障碍对应的校正后变化量介于-5.1（对应"感觉自己年纪太大"，95%置信区间：-9.4~-0.8）至-15.6（对应"腿脚溃疡"，95%CI：-24.8~-6.5）之间。本研究发现医护人员态度与运动障碍之间存在显著交互作用，校正后P值介于0.03（对应"我不认为医师或护士有义务为透析患者提供运动指导"）至0.001（对应"我不常询问患者的运动情况"）之间。仅在无运动障碍的患者中，医护人员积极主动的态度才会产生有益效应。

### 研究结论
运动障碍与医护人员消极被动的态度均会降低血液透析患者的身体活动水平。无运动障碍的患者可从医护人员积极主动的态度中获得最大收益。