Enhancement of Adherence to Therapeutic and Lifestyle Recommendations Among Hemodialysis Patients: An Umbrella Review of Interventional Strategies

Figures & data

Table 1 The Utilized Quality Appraisal Tools in the Retrieved Systematic Reviews of Interventions to Enhance Therapeutic and Lifestyle Recommendations Adherence Among Hemodialysis Patients.

Author, Year	The Applied Quality Appraisal Tool
Barcellos et al 2015^Citation27	Cochrane Collaboration’s assessment tool^Citation42
Gomes et al 2018^Citation28	PEDro* scale^Citation43
Bouya et al 2018^Citation31	Jadad scale for experimental and JBI** appraisal tool for quasi-experimental studies^Citation44,Citation45
Campell et al 2015^Citation29	Academy of Nutrition and Dietetics (AND) quality criteria checklist for primary research^Citation46
Jeddi et al 2017^Citation30	Cochrane Collaboration’s assessment tool^Citation47
Idier et al 2011^Citation20	Not stated
Karavetian et al 2014^Citation21	Not stated
Mason et al 2008^Citation22	Jadad scale for experimental studies^Citation44
Matteson et al 2010^Citation23	Not stated
Milazi et al 2017^Citation6	JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI)^Citation48
Pascoe et al 2017^Citation24	Cochrane Collaboration’s assessment tool^Citation42
Reid et al 2011^Citation25	JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI)^Citation48
Sharp et al 2005^Citation26	Authors’ developed quality criteria based on the recommended guidelines to conduct SRs*** in HCR****^Citation49

Notes: *Physiotherapy Evidence Database (PEDro). **Joanna Briggs Institute. ***Systematic reviews. ****Health care research.

Figure 1 The PRISMA flow diagram of the publications screening process in the umbrella review of interventional studies* to enhance therapeutic and lifestyle recommendations adherence among hemodialysis patients.

Notes: * The identified publications in the literature review included: Cochrane Database of Systematic Reviews (n= 66), OVID (n= 135), PubMed (n= 120), Scopus (n= 96), EMBASE (n= 161) and Web of Science (n= 149).

Table 2 List of the Retrieved Publications that Reported Interventions to Enhance Therapeutic and Lifestyle Recommendations Adherence Among Hemodialysis Patients.

Author, Year, Study Location	Intervention (Study Population)	Included Studies Number, Design, Search Time Limit	Number of Participants/ Study Setting	Main Results/Findings
Barcellos et al^Citation27 2015 – Brazil	Aerobic and resistance exercises training (KTPs, PDPs, HDPs)	59 RCTs, up to June 2015	2858 Tertiary settings	Health-related quality of life, physical fitness, heart rate variability, pulse wave velocity and arterial stiffness, lipid profile, inflammatory markers, body composition, CKD progression, depression
Gomes et al^Citation28 2018 – Brazil	Aerobic and resistance exercise (HDPs)	56 RCTs, up to December 2017	2586 Tertiary settings	Reduced depression symptoms: (effect size: −9.3, −5.3)
Bouya et al^Citation31 2018 – Iran	Aromatherapy by inhalation and massage (HDPs)	22 RCTs, NRCT, quasi-experiments, up to 30 Dec 2017	1087 Primary settings	Reduced hemodialysis related anxiety, depression and stress
Campell et al^Citation29 2015 – Australia	Dietary education/monitoring through mobile apps (CKDPs, HDPs)	5 (RCTs & case studies), up to 2014	122 Primary settings	No changes in nutrient intake, biochemical marker or IDWG
Jeddi et al^Citation30 2017 – Iran	Dietary education/and monitoring through mobile apps and wearable devices (CKDPs)	8 RCTs, up to May 2016	1637 Primary settings	Improved medication adherence, patients’ knowledge and dietary sodium intake
Idier et al^Citation20 2011 – France	Motivational/psycho-educational interventions/counseling (HDPs)	35 RCTs, NRCTs, CBAs, 1972 – 2011	2318 Primary settings	Improved dietary and fluid adherence/phosphorus, potassium levels, quality of life and reduced depression
Karavetian et al^Citation21 2014 – The Netherlands	Self-regulation education/motivational counseling (HDPs)	18 RCTs, quasi-experiments, up to June 2013	1982 Primary settings	Reduced serum phosphate levels (effect size: −0.13 to −8.0 mg/dl)
Mason et al^Citation22 2008 – UK	Educational and psychological interventions (KTPs, PDPs, HDPs)	22 RCTs, 1980-2007	1967 Primary/Tertiary settings	Improved fluid intake and diet concordance/potassium and phosphorus levels/quality of life and reduced depression
Matteson et al^Citation23 2010 – USA	Self-regulation/self-efficacy education/hypnotherapy/coaching (HDPs)	8 RCTs, up to 2008	594 Primary settings	Improved diet adherence and phosphorus level (effect size: 0.04 to 0.74)
Milazi et al^Citation6 2017 – Australia	Behavioral/psychological interventions (HDPs)	18 (RCTs, NRCTs, CBAs, cohort studies), 2005-2015	2760 Primary/Tertiary settings	Reduced serum phosphate levels (weighted mean difference = - 0.23 mmol/l, 95% CI - 0.37, - 0.08)
Pascoe et al^Citation24 2017 – Australia, UK	CBT, social support, counseling, roleplaying skills demonstration (CKDPs)	8 RCTs, up to May 2016	515 Primary/Tertiary settings	Greater relief of depressive symptoms
Reid et al^Citation25 2011 – Australia	CBT, self-efficacy training/contract with a FM/F to care patient/(HDPs)	5 RCTs, NRCTs, CBAs 1966-2009	417 Primary/Tertiary settings	Reduced IDWG, depression and improved quality of life/self-care, self-efficacy and psychosocial skills
Sharp et al^Citation26 2005 – UK	CBT, educational interventions, (HDPs)	12 RCTs, observational studies, up to January 2004	863 Primary/Tertiary settings	Improved fluid intake regimen/decreased IDWG.

Table 3 The Objectives, Types of Interventions and Outcome Measures in the Retrieved Systematic Reviews of Interventions to Enhance Therapeutic and Lifestyle Recommendations Adherence Among Hemodialysis Patients.

Author, Year	Study Objective in Effectiveness Assessment of	Types of Interventions	Outcome Measures
Barcellos et al 2015^Citation27	Exercise interventions	Aerobic and resistance exercises training	Health-related quality of life, physical fitness, heart rate variability, pulse wave velocity and arterial stiffness, lipid profile, inflammatory markers, body composition, CKD progression, depression
Gomes et al 2018^Citation28	Intradialytic exercise training	Combined intradialytic aerobic and resistance exercise	VO2 max, depression, physical function, vitality, health-related QOL, walk test distance, knee extensor strength
Bouya et al 2018^Citation31	Aromatherapy interventions	Massage and inhalation aromatherapy	Fatigue, stress, pain, depression, anxiety, sleep quality, pruritus, headache, pruritus, pain of arteriovenous fistula puncture and QOL
Campell et al 2015^Citation29	Mobile apps application	Personal digital assistant (PDA) use to self-monitor dietary and fluid intake	Nutrient intake (sodium, potassium, phosphorus, fluid, protein and energy), biochemical markers (serum albumin, potassium and phosphorus), IDWG
Jeddi et al 2017^Citation30	Automated IT-based interventions	Wearable devices use to measure BP and PDA use to provide nutrition guideline	Medication adherence, patients’ knowledge, dietary sodium intake, BP, IDWG, parathyroid hormone level, ultrafiltration rate
Idier et al 2011^Citation20	TPE programs	Motivational/psycho-educational interventions/counseling	Knowledge, QOL, dietary, fluid and medication adherence, phosphorus, potassium levels, depression
Karavetian et al 2014^Citation21	Optimal nutrition education methods for management of hyperphosphatemia	Education of self-evaluation and self-regulation techniques, individualized counseling,	Serum phosphate levels
Mason et al 2008^Citation22	Short-, medium-, and long-term impacts of educational interventions	Collaborative role learning, psycho-social support, self-monitoring, goal setting, self-regulation & stress management skills education, CBT	Intention to initiate dialysis, knowledge/attitude toward self-care dialysis, survival rates, time to dialysis, depression, anxiety, perceived social support, physical fitness, social functioning, IDWG, emotional functioning, self-care efficacy, adaptation to CKD & dialysis, diet/fluid restriction, medication concordance, satisfaction, locus of control, death acceptance & suicidal thinking, QOL, serum calcium, phosphorus & albumin, potassium & parathyroid hormone levels
Matteson et al 2010^Citation23	Different RCTs’ impacts	Cognitive, behavioral and hypnotherapy coaching, self-monitoring skills education, stress reduction exercises, self-efficacy training	Dietary sources of phosphorus management, treatment time adherence, diet/medication or fluid adherence
Milazi et al 2017^Citation6	Education or behavioral interventions	Educational and/or behavioral interventions	Serum phosphate levels, knowledge/adherence/perceived self-efficacy/self-management behavior to phosphate control
Pascoe et al 2017^Citation24	Psychosocial interventions on patients and/or their carers	Psychosocial intervention with supportive therapy	Depression, anxiety symptoms or QoL in CKD patients and/or their carers
Reid et al 2011^Citation25	Nursing interventions	Individualized self-efficacy training, group CBT, teaching and supporting	Adherence with hemodialysis treatment, depression and/or anxiety, QOL, care provider burnout, social support, satisfaction
Sharp et al 2005^Citation26	Psychological interventions	Self-regulation/self-monitoring education, social reinforcement, stress management, CBT	IWG, blood pressure, blood urea nitrogen level, potassium level, health beliefs, self-efficacy

Abbreviations: CKD, chronic kidney disease; HRV, heart rate variability index; PWV, pulse wave velocity; BMI, body mass index; TC, total cholesterol; HDL, high density lipoprotein; LDL, low density lipoprotein; TG, triglyceride; HDs, hemodialysis; QOL, quality of life; VO2 max, maximum rate of O2 consumption during incremental exercise; IDWG, interdialytic weight gain; TPE, therapeutic patient education; BP, blood pressure; PDA, personal digital assistant; CBT, Cognitive Behavioral Therapy; ESRD, end-stage renal disease.

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