Achieving consensus on psychosocial and physical rehabilitation management for people living with kidney disease

Emma Coyne; Juliet Briggs; Fiona Loud; Paul Bristow; Hannah M L Young; Ellen M Castle; Courtney J Lightfoot; Matthew Graham-Brown; Margaret Eyre; Paula Ormandy; Amrit Sachar; Amanda Bevin; James O Burton; Thomas J Wilkinson; Pelagia Koufaki; Jamie Macdonald; Neil Ashman; Sharlene A Greenwood

doi:10.1093/ckj/sfad116

Achieving consensus on psychosocial and physical rehabilitation management for people living with kidney disease

Clin Kidney J. 2023 May 19;16(11):2185-2193. doi: 10.1093/ckj/sfad116. eCollection 2023 Nov.

Authors

Emma Coyne¹, Juliet Briggs², Fiona Loud³, Paul Bristow⁴, Hannah M L Young⁵, Ellen M Castle⁶, Courtney J Lightfoot⁷, Matthew Graham-Brown⁸, Margaret Eyre⁹, Paula Ormandy¹⁰, Amrit Sachar¹¹, Amanda Bevin¹², James O Burton⁸, Thomas J Wilkinson^{5

13}, Pelagia Koufaki¹⁴, Jamie Macdonald¹⁵, Neil Ashman¹⁶, Sharlene A Greenwood^{2

17}

Affiliations

¹ Nottingham University Hospitals NHS Trust, Nottingham, UK.
² Renal Therapies, King's College Hospital NHS Trust, London, UK.
³ Kidney Care UK, Alton, Hampshire UK.
⁴ Kidney Care UK, Alton, HampshireUK.
⁵ Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
⁶ Physiotherapy Division, College of Health Medicine and Life Sciences, Brunel University, London, UK.
⁷ Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁸ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁹ York and Scarborough Teaching Hospitals NHS Trust, York, UK.
¹⁰ University of Salford, Manchester, UK.
¹¹ Imperial College Healthcare NHS Trust & West London NHS Trust, London, UK.
¹² Kent and Canterbury Hospital, Canterbury, London, UK.
¹³ National Institute of Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester, UK.
¹⁴ Queen Margaret University, Edinburgh, UK.
¹⁵ Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK.
¹⁶ The Royal London Hospital NHS Trust, London, UK.
¹⁷ Faculty of Life Sciences and Medicine, King's College London, London, UK.

Abstract

Background: People living with chronic kidney disease (CKD) need to be able to live well with their condition. The provision of psychosocial interventions (psychological, psychiatric and social care) and physical rehabilitation management is variable across England, as well as the rest of the UK. There is a need for clear recommendations for standards of psychosocial and physical rehabilitation care for people living with CKD, and guidance for the commissioning and measurement of these services. The National Health Service (NHS) England Renal Services Transformation Programme (RSTP) supported a programme of work and modified Delphi process to address the management of psychosocial and physical rehabilitation care as part of a larger body of work to formulate a comprehensive commissioning toolkit for renal care services across England. We sought to achieve expert consensus regarding the psychosocial and physical rehabilitation management of people living with CKD in England and the rest of the UK.

Methods: A Delphi consensus method was used to gather and refine expert opinions of senior members of the kidney multi-disciplinary team (MDT) and other key stakeholders in the UK. An agreement was sought on 16 statements reflecting aspects of psychosocial and physical rehabilitation management for people living with CKD.

Results: Twenty-six expert practitioners and other key stakeholders, including lived experience representatives, participated in the process. The consensus (>80% affirmative votes) amongst the respondents for all 16 statements was high. Nine recommendation statements were discussed and refined further to be included in the final iteration of the 'Systems' section of the NHS England RSTP commissioning toolkit. These priority recommendations reflect pragmatic solutions that can be implemented in renal care and include recommendations for a holistic wellbeing assessment for all people living with CKD who are approaching dialysis, or who are at listing for kidney transplantation, which includes the use of validated measurement tools to assess the need for further intervention in psychosocial and physical rehabilitation management. It is recommended that the scores from these measurement tools be included in the NHS England Renal Data Dashboard. There was also a recommendation for referral as appropriate to NHS Talking Therapies, psychology, counselling or psychotherapy, social work or liaison psychiatry for those with identified psychosocial needs. The use of digital resources was recommended to be used in addition to face-to-face care to provide physical rehabilitation, and all healthcare professionals should be educated to recognize psychosocial and physical rehabilitation needs and refer/sign-post people with CKD to appropriate services.

Conclusion: There was high consensus amongst senior members of the kidney MDT and other key stakeholders, including those with lived experience, in the UK on all aspects of the psychosocial and physical rehabilitation management of people living with CKD. The results of this process will be used by NHS England to inform the 'Systems' section of the commissioning toolkit and data dashboard and to inform the National Standards of Care for people living with CKD.

Keywords: CKD; exercise; physical activity; psychosocial; rehabilitation.