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Kidney Week

Abstract: TH-PO671

Hemodialysis Patients Who Receive Physical Therapy: An Opportunity to Modify the Frailty Trajectory?

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Kutner, Nancy G., Emory University School of Medicine, Atlanta, Georgia, United States
  • Huang, Yijian, Emory University, Atlanta, Georgia, United States
Background

Frailty markers, physical activity and gait speed (and muscle strength to a lesser extent), show decline over time among hemodialysis (HD) patients (J Gerontol 2019), but whether these patterns vary in association with receipt of physical therapy (PT) has not been investigated. In Medicare claims, we identified dates and types of outpatient PT services received by HD patients during their participation in the USRDS ACTIVE-ADIPOSE Study (AAS). We examined frailty measures assessed before and after receipt of PT that included therapeutic exercises (CPT code 97110) “to develop strength and endurance, range of motion and flexibility.”

Methods

The AAS included a multi-center cohort of 771 prevalent HD patients aged 20-92 and was conducted 2009-2013 at 14 outpatient dialysis clinics in the Atlanta GA and San Francisco areas. Institutional review boards (Emory University; UCSF) approved the study and all participants provided written informed consent. At baseline and two annual follow-up assessments, trained study coordinators administered the Minnesota Leisure Time Activity (LTA) instrument to estimate kcal/week physical activity, and the Short Physical Performance Battery (SPPB) that includes chair stand, balance, and walk (gait speed) tests. Consistent with prior research, individuals with LTA-assessed kcal/week <500 were considered sedentary and 500+ non-sedentary, and total SPPB score (0-12) was categorized into three ordinal groups (<6, 7-9, 10-12).

Results

Medicare claims for outpatient PT were identified for 32 AAS participants: ages 32-82, 57% women, 81% black. Patient-reported reasons for PT emphasized mobility issues. At their post-PT follow-up evaluation: (1) Half had LTA scores = 500+ (non-sedentary), and kcal/week activity had increased from <500 pre-PT to 500+ post-PT for half of the non-sedentary group; (2) Although measured gait speed for most participants post-PT was consistent with values that characterize “limited community ambulators” (0.4-0.8 m/sec), two-thirds of participants either maintained SPPB scores > 7 pre-post PT or achieved SPPB scores > 7 post-PT.

Conclusion

Continued study of the role of PT in HD patient care is merited in larger patient cohorts. PT goals are patient-specific and include maintenance as well as improvement of function, with implications for the trajectory of frailty.

Funding

  • NIDDK Support