| Popis: |
Fatigue is the most common symptom reported by people with kidney failure receiving haemodialysis (HD), and it adversely impacts their health-related quality of life (HRQoL). Educational interventions involving energy conservation strategies have effectively reduced fatigue and improved HRQoL in people with cancer and multiple sclerosis. This thesis is primarily aimed at documenting the effectiveness of an energy conservation education intervention for people with kidney failure receiving HD (EVEREST). The organisation of the thesis follows a traditional structure with an introduction, literature review, theoretical framework, methods, results, discussion, and conclusion chapters. This thesis comprises a study undertaken in two phases. Phase One involved the translation and validation of the Integrated Palliative care Outcome Scale-renal (IPOS-renal) in the Nepali language. Analysis of this phase involved determining the content validity and internal consistency reliability of the Nepali version of IPOS-renal (N.IPOS-renal). In Phase Two, a pragmatic cluster randomised controlled trial (pCRT) guided by the symptom management theory (SMT) was conducted to evaluate the effectiveness of an energy conservation education intervention in people with kidney failure receiving HD in a tertiary dialysis centre in Nepal. One hundred and twenty-six participants receiving HD who met the eligibility criteria were recruited and cluster randomised based on HD shifts (intervention group, n = 63; control group, n = 63). The intervention group received a structured energy conservation education (ECE) program plus usual care over 12 weeks. The ECE program consisted of three individual face-to-face educational sessions, one booster session, and a booklet that contained information about strategies to conserve energy. The primary outcome was the four dimensions of fatigue: fatigue severity, frequency, interference, and daily pattern, which were measured at baseline, week four, week eight, and week 12 using the Fatigue Symptom Inventory (FSI). Secondary outcomes were other chronic kidney disease (CKD) symptoms, occupational performance, and HRQoL measured at baseline and week 12 using N.IPOS-renal, Canadian Occupational Performance Measure (COPM) and SF-36 Questionnaire, respectively. Socio-demographic characteristics, clinical characteristics and blood test results were also collected. Intention-to-treat analysis using a linear mixed model (LMM) was used to assess changes in the primary and secondary outcomes between the groups over time. Data were analysed using the Statistical Package for Social Sciences (SPSS, version 28), and statistical significance was set at p < .05. |
