An International Delphi Survey on Exercise Priorities in CKD

Mary Labib; Clara Bohm; Jennifer M MacRae; Paul N Bennett; Kenneth R Wilund; Mara McAdams-DeMarco; Manisha Jhamb; Stefan Mustata; Stephanie Thompson; Global Renal EXercise Network

doi:10.1016/j.ekir.2020.12.001

An International Delphi Survey on Exercise Priorities in CKD

Kidney Int Rep. 2020 Dec 18;6(3):657-668. doi: 10.1016/j.ekir.2020.12.001. eCollection 2021 Mar.

Authors

Collaborators

Global Renal EXercise Network:
Mary Labib, Clara Bohm, Jennifer M MacRae, Paul N Bennett, Kenneth R Wilund, Mara McAdams-DeMarco, Manisha Jhamb, Stefan Mustata, Stephanie Thompson

Affiliations

¹ Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
² Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Medical Clinical Affairs, Satellite Healthcare, San Jose, California, USA.
⁵ Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
⁶ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
⁷ Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
⁸ Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

Introduction: Defining the role of exercise in chronic kidney disease (CKD) is a top research priority for people with CKD. We aimed to achieve consensus on specific research priorities in exercise and CKD among an international panel of stakeholders.

Methods: Using the Delphi method, patients/caregivers, researchers, clinicians, and policymakers submitted their top research priorities in round 1 and ranked their importance in rounds 2 and 3 using a 9-point Likert scale. The mean, median, and proportion of scores ranked 7 to 9 were calculated. Consensus was defined as priorities that scored above the overall mean and median score within each stakeholder panel. Qualitative description was used to understand participants' rankings.

Results: Seventy participants (78% response) completed round 1: 15 (21.4%) clinicians, 33 (47.1%) researchers, 13 (18.6%) policymakers, and 9 (12.9%) patients; (85.7%) completed round 3. The top research priorities were defining exercise-related outcomes meaningful to patients, identifying patients' motivation and perspective towards exercise, understanding the effect of exercise on the risk of institutionalization, mortality, and mobility, and understanding the effect of pre- and post-transplant exercise on postoperative recovery. Themes from the qualitative analysis were individualization, personal experience, and holistic approach to exercise (patients), the need to address common clinical problems (clinicians), developing targeted interventions (researchers), and the importance of evidence-based development versus implementation (policymakers).

Conclusions: Preventing physical disability was a common priority. Policymakers emphasized that more efficacy studies were needed. Other panels expressed the need for holistic and targeted exercise interventions and for outcomes that address common clinical problems.

Keywords: Delphi; chronic kidney disease; exercise; outcomes; research priorities; survey.