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Patients receiving hemodialysis (HD) often experience fatigue, time constraints, and impaired mobility, leading to frailty. This condition invariably contributes to a decline in gait performance, decreased physical activity, a compromised quality of life, as well as a heightened mortality risk. Recent explorations propose the potential for intradialytic electrical stimulation (E-stim) as a method of augmenting physical activity and mobility capabilities. The purpose of our study was to test the efficacy of a 12-week intradialytic plantar E-stim intervention in outpatients subjected to HD as a result of this premise.
Participants were allocated randomly into two groups: the intervention group (IG, n=48) and the control group (CG, n=49). Those in the IG received a one-hour plantar E-stim treatment concurrent with their regular tri-weekly HD sessions. The CG, on the other hand, had a visually identical but non-operational device applied for the same duration over a 12-week period. In the straight walkway, gait tasks were conducted including single-task (i.e., habitual walking), dual-task (DT: walking while back-counting numbers), and faster walking (FW). To assess daily physical activity, participants wore a monitoring pendant for two consecutive days both at the onset of the study and following the 12-week intervention.
A total of 97 HD patients were successfully recruited (IG (n=48): age= 54.51 ± 11.95 years; Body mass index=30.79 ± 6.21 kg/m2; Female= 30.6%; pre-frail to frail= 83.7%; Diabetes duration: 21.04 ± 7.52 years; CG (n=49): age= 53.42 ± 14.18 years; Body mass index=31.14 ± 6.99 kg/m2; Female= 31.90%; pre-frail to frail= 85.4%; Diabetes duration: 18.54 ± 7.56 years), and age, BMI, sex, and frailty rates are not significantly different between IG and CG. Remarkable group*time interaction effects were noted in terms of gait performance at DT (stride time: p=0.031, d=0.449; cadence: p=0.029, d=0.459) and FW (stride time: p=0.032, d=0.449; cadence: p=0.014, d=0.514) (Figure 1). In addition, postural transition parameters in physical activity showed significant group*time interaction effects in stand-to-walk (p=0.018, d=0.496), stand-to-sit (p=0.021, d=0.483), and sit-to-walk (p=0.021, d=0.483) (Figure 2). The IG demonstrated notable enhancements in cadence at DT (+7.38%, Cohen's d=0.575) and stand-to-walk (+16.7%, Cohen's d=0.227) from baseline to the 12-week mark. In contrast, the CG showed relatively little improvement in cadence at DT (+2.45%, Cohen's d=0.217) and decreased stand-to-walk (-10.30%, Cohen's d=0.178).
This study highlights that a 12-week regimen of intradialytic plantar E-Sim substantially enhances both gait performance and physical activity in HD patients. In light of these findings, it is recommended that E-Stim be integrated into routine hemodialysis treatment as an adjunctive measure to enhance and maintain functional performance for patients.