Abstract
People with chronic kidney disease on hemodialysis present many comorbidities, including malnutrition and frailty. These factors contribute to a sedentary lifestyle, cognitive impairment, and decreased emotional well-being. Intradialytic exercise with non-immersive virtual reality may improve health-related quality of life and functional capacity in these individuals.
The GoodRENal project was developed to create a digital intradialytic health platform to improve health-related quality of life. This study aimed to test the feasibility of the GoodRENal intradialytic platform and to identify participants’ opinions about the use of the platform.
People on hemodialysis treatment from Spain, Greece and Sweden were included. Non-immersive virtual reality games were created to educate on food intake aiming to better control potassium, phosphate, sodium and liquids. It also aimed at increasing physical activity during HD sessions, improving cognitive skills and enhancing psychological well-being. An Azure Kinect camera was used to capture the movement and all activities were designed as dual-tasks, so the movement of lower limbs was promoted in every game. During a trial session, patients were asked about their perception of the platform through a questionnaire designed to evaluate their opinion. It consisted of 10 general questions, 6 questions for the Physical Activity games, 4 for the Nutrition games, 6 for the Cognition games and 7 for the Psychology games. Every question was rated with a Likert scale. Answers are presented in three categories ‘agree’ (4 or 5 out of 5), ‘neither agree nor disagree’ (3 out of 5), and ‘disagree’ (1 or 2 out of 5).
27 participants were included in this study (Spain n = 9; Greece n = 10; Sweden n = 8). Participants’ mean age was 64.6 years, 9 women, with a hemodialysis vintage, median 27 months (minimum 4- maximum 240). The questions with a higher degree of agreement or disagreement are summarized. In terms of general feedback on the GoodRENal platform, more than 90% of respondents found the instructions easy to follow and that playing the games was a pleasant break during the hemodialysis session. Furthermore, they disagreed with the statement that the back was tiring. The questions related to the physical activity games with the highest rate of agreement related to the ideas that the program provides a good workout (80% agreement), the possibility to have more exercises (70% agreement) and that it was fun (60% agreement). Regarding the nutrition games, more than 70% agreed that they had gained new knowledge about what to eat and about 60% felt motivated to modify what they ate. For the cognition games, more than 80% maintained attention during the games, but only 35% felt motivated to engage in cognitively stimulating activities. Finally, regarding the games aimed at emotional well-being, 30% of the patients indicated that they felt good about the exercises.
The GoodRENal platform is a feasible strategy to increase physical activity during hemodialysis treatment, as well as to improve nutritional information and cognitive status of patients. As a general impression the platform was easy to follow and it was a nice break. Future studies should take into account participants’ opinion to improve the content of a digital intradialytic health platform.
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