|Year : 2019 | Volume
| Issue : 2 | Page : 98-100
Restorative occupational therapy for adolescents with chronic kidney disease
Lili Chan1, Alison Ma2, Sanne Fong1, Ellen Yu3, Phoebe Chan1, Hellen Yang1, Euan Soo2, WM Lai2
1 Department of Occupational Therapy, Hong Kong Children's Hospital, Hong Kong
2 Department of Paediatrics and Adolescent Medicine, Paediatric Nephrology Centre, Princess Margaret Hospital, Hong Kong
3 Clinical Research Centre, Princess Margaret Hospital, Hong Kong
|Date of Web Publication||4-Dec-2019|
Department of Paediatrics and Adolescent Medicine, Paediatric Nephrology Centre, Princess Margaret Hospital
Source of Support: None, Conflict of Interest: None
Occupational therapy is demonstrated to improve quality of life and enable rehabilitation of patients with various chronic diseases. However, their role in managing children with chronic kidney disease (CKD) remains unclear. Twelve adolescents with CKD managed at a single center in Hong Kong participated in a 4-weeks occupational lifestyle redesign program (OLSRP) comprising 8 sessions of self-initiated individualized activity plans, led by two occupational therapists. Two surveys, the self-management inventory and Chinese version of General Self-efficacy Scale, administered at initiation and end of OLSRP, were used to examine its impact on competence, confidence and self-efficacy scores. Following OLSRP, 91.7% and 75% of 12 adolescents showed significant improvements in composite scores of both scales, with significant increments in self-management concerning disease, social and collaborative skills, diet, proper schedule, medication intake and acceptance of their disease, and problem solving and confidence.
Keywords: Pediatric, occupational lifestyle redesign programme, rehabilitation
|How to cite this article:|
Chan L, Ma A, Fong S, Yu E, Chan P, Yang H, Soo E, Lai W M. Restorative occupational therapy for adolescents with chronic kidney disease. Asian J Pediatr Nephrol 2019;2:98-100
|How to cite this URL:|
Chan L, Ma A, Fong S, Yu E, Chan P, Yang H, Soo E, Lai W M. Restorative occupational therapy for adolescents with chronic kidney disease. Asian J Pediatr Nephrol [serial online] 2019 [cited 2020 Apr 3];2:98-100. Available from: http://www.ajpn-online.org/text.asp?2019/2/2/98/272309
| Introduction|| |
Children and adolescents with kidney diseases face emotional, psychological and social challenges during their growth. Occupational therapy plays a vital role. Ng et al. has previously demonstrated the effectiveness of occupational lifestyle redesign program (OLSRP) in filling the gap of psychosocial adaptation in conventional stroke rehabilitation. Patients who took part in OLSRP had improved motivation levels and predicted better quality of life on long term.
During 2017–2018, we implemented the 4-week OLSRP for adolescents with kidney diseases in summer holidays at our hospital. The program aimed to promote healthy lifestyle, enhance patient confidence in management of their illness, and facilitate transition from adolescence to an adult role with hope of pursuing a meaningful life. We report our experience on the use and outcomes of this program.
| Methods|| |
During 2017 and 2018, we launched a 4-week OLSRP comprising of 8 sessions, each of 3-hr duration, in the Pediatric Nephrology Unit, Princess Margaret Hospital, Hong Kong. Two occupational therapists led the program. Adolescents with chronic kidney diseases (CKDs), referred by the Pediatric Nephrology team, were included. A multidisciplinary conference was held for each patient by the team, composed of renal nurses, occupational therapists, physiotherapists, dietitians, pharmacists and clinical psychologists. To maximize impact of the program, the program was focused on each participant, with different educational themes in each session [Table 1].
|Table 1: Theme and objectives of each session of the occupational lifestyle redesign program|
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Participants were encouraged for their opinion through active participation of specially designed activities, such as cooking, horticulture and outdoor sessions [Figure 1]. A weekly self-initiated activity plan from every individual participant was encouraged. Outdoor activity of each group was organized by the patients under supervision of occupational therapists. Patients had an opportunity to practice the skills learnt, including planning and organizing, management of time, conflicts and money, and ensuring healthy lifestyle.
The therapists distributed two surveys, the Self-management Inventory and the Chinese version of Chinese version of general self-efficacy scale (CGSS), at the first session and 4-weeks after the concluding session. The self-management Inventory is a 10-item questionnaire requiring participants to indicate their perceived competence or confidence on the 10-point visual analogue scale. The Chinese version of CGSS, validated by local occupational therapists, also consists of 10 items assessing belief of ability with a 4-point scale ranging from 1 (not at all true) to 4 (exactly true). For both scales, a higher score indicates higher level of competence, confidence or self-efficacy. Written consent for use of data was obtained from the participants. Data were analyzed using the IBM SPSS statistical for window (version 22.0 Armonk, NY, USA). Continuous and categorical variables are shown as mean ± standard deviation and count with percentage, respectively. Pre- and post-scores were determined and compared using paired t-test or Wilcoxon sign rank test; mean difference was also estimated. P < 0.05 was considered significant.
| Results|| |
Twelve adolescents (6 boys), between 13 and 18 years of age, attended the sessions in 2017 and 2018. Five patients had congenital abnormalities of kidney and urinary tract, six had glomerulonephritis and one had hypoxic-ischemic nephropathy due to perinatal insult. Four patients each had undergone kidney transplantation; 4 were on peritoneal dialysis and 4 on hemodialysis; 2 patients had CKD not requiring dialysis.
Of 12 participants, 91.7% and 75% had improvement after the OLSRP on the composite score of self-management inventory and CGSS, respectively [Table 2] and [Table 3]. Significant score increment was found in self-management concerning disease (mean difference 2.1 ± 3.1; P = 0.035), social and collaborative skills (1.6 ± 2.7; P = 0.028), diet (1.1 ± 1.1; P = 0.005), proper schedule (1.8 ± 2.6; P = 0.005), medication intake (1.2 ± 1.2; P = 0.005) and acceptance of their disease (2.4 ± 2.7; P = 0.004). Similarly there was better scores on CGSS, including problem solving (0.7 ± 0.8; P = 0.021) and confidence (0.5 ± 0.5; P = 0.014).
|Table 2: Self-management inventory score of participants taking occupational lifestyle redesign program in 2017-2018; n=12|
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|Table 3: General self-efficacy scale (CGSS) of participants taking occupational lifestyle redesign program in 2017-2018; (n=12)|
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| Discussion|| |
This report focuses on the benefits of occupational therapist led OLSRP in adolescents with CKDs. Occupational therapy is one of the most important aspects of renal rehabilitation, which incorporates interventions and strategies to restore physical, psychological and social functioning. Most existing reports and studies focus on adults with kidney diseases.,, Better therapies have resulted in longer life-expectancy and the need for medical professionals to take psychosocial needs into account. A recent report suggested that occupational therapy can improve the quality of daily living of patients with renal diseases.
The present report shows that young patients had marked improvement in self-management and efficacy after this program [Figure 1]. With this positive attitude, these young patients would look forward to a better quality of life. It was encouraging to see the growth of each person in terms of maturity and capability in problem solving after the program. One of the biggest challenges in running this program was to engage the adolescents to attend all sessions, and ensure enthusiasm. Apart from effort of the occupational therapists, success of the program was possible because of robust support of the multidisciplinary team.
There are limitations of this OLSRP review. The program is currently on a small scale with few patients. We did not examine the direct effect of enhanced self-management and efficacy on practical issues such as improvement of drug compliance or quality of life. This is certainly the direction for future reviews. Our experience does, however, show that adolescent patients benefit from the program. With this experience, we propose to enrich our program with more flexible schedules from an adolescent perspective, provide comprehensive rehabilitation for adolescents burdened with kidney diseases, and help them through transition as young adults.
Financial support and sponsorship
The program was supported by Princess Margaret Hospital charity fund.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ng SW, Chin MH, Cheung SH, Leung KF, Chan YL, Chan SM, et al
. Occupational Lifestyle Redesign Programs: Theory & Practice. Published by Hong Kong Occupational Therapy Association; Hong Kong, 2014. Available at: https://hkota.org.hk/publication
. [Last accessed on 20 Nov 2019].
Chiu FP, Tsang HW. Validation of the Chinese general self-efficacy scale among individuals with schizophrenia in Hong Kong. Int J Rehabil Res 2004;27:159-61.
Rochette A, Korner-Bitensky N, Levasseur M. 'Optimal' participation: A reflective look. Disabil Rehabil 2006;28:1231-5.
Padilla J, Krasnoff J, Da Silva M, Hsu CY, Frassetto L, Johansen KL, et al
. Physical functioning in patients with chronic kidney disease. J Nephrol 2008;21:550-9.
Curtin RB, Lowrie EG, DeOreo PB. Self-reported functional status: An important predictor of health outcomes among end-stage renal disease patients. Adv Ren Replace Ther 1999;6:133-40.
Goto Y. Renal rehabilitation in occupational therapy for patients with chronic kidney disease. Phys Med Rehabil Res 2017;2:1-3.
[Table 1], [Table 2], [Table 3]