MP409DEVELOPMENT OF A SELF-DIRECTED PROGRAMME TO INCREASE PHYSICAL ACTIVITY IN CHRONIC KIDNEY DISEASE

Abstract

Introduction and Aims: Engaging in moderately-vigorous physical activity (MVPA) has been shown to improve the symptom burden of CKD, reduce cardiovascular risk and improve quality of life however the patient population remains inactive. The SPARK project aims to create a self-directed intervention, underpinned by behaviour change theory, to promote MVPA for people with CKD not requiring renal replacement (non-RRT CKD), and produce the positive results seen in other chronic diseases. The development process has been guided by the Medical Research Council (MRC) framework for the development of complex interventions. Methods: An initial design was developed based on successful interventions in other chronic diseases and informed by previously published qualitative data to ensure applicability to people with non-RRT CKD. It comprised a 6 week walking intervention, grounded in the Theory of Planned Behaviour and delivered using Motivational Interviewing, supported by written educational material and telephone calls to facilitate progression and engagement. This nascent design was iteratively reviewed at two expert panel meetings, one PPI session, two patient focus groups and individual meetings. The Expert/PPI Panel included patients & relatives, members of the specialist renal MDT (physiotherapists, dieticians, pharmacist, nurse & consultants), health psychologists, an exercise physiologist and a behaviour change expert. Two patient focus groups were held (n=10; 5 male; mean age= 68 years; mean eGFR=42.4mL/min/1.73m2) with patients recruited from out-patient appointments. The group sessions were digitally recorded, professionally transcribed verbatim, anonymised and analysed in N Vivo. The transcripts were subject to deductive thematic analysis, identifying themes at a semantic level. Topics reviewed included the aims of project; content and format of the intervention and the supporting material; types of exercise to be used; role of self-monitoring and level of support from professionals. Results: The intervention was viewed enthusiastically by both professionals and patients. Changes to the intervention design made in response to feedback included: extending the length of the intervention from 6 to 8 weeks, switching from one A4 to two A5 educational booklets and adding pedometer use. Changes made to the content of the written material included reducing repetition; adding summaries at the start of each chapter to emphasise key points; and changing the emphasis from "exercise" to "physical activity" and "being active". Conclusions: People with non-RRT CKD are an inactive population who have the potential to significantly reduce cardiovascular risk and improve quality of life by engaging in MVPA. This intervention has been developed in a person-centred manner based on the MRC framework for developing complex interventions. Positive feedback from both professionals and patients was received and thus the next stage of the SPARK project is to iteratively test the intervention design in practice.