R ARNOLD 1, K SHAH 1, S LIU 1, J THOM 1, C FOOTE 2, S SEN 2
1UNSW Sydney, Kensington, Australia, 2Concord Repatriation General Hospital, Concord, Australia
Aim: We aimed to identify whether self-reported symptoms on the Integrated Palliative Care Outcome Scale Renal (iPOS-R) related to use of health-district supported transport services.
Background: Accelerated decline in physical function is apparent in End-Stage Kidney Disease (ESKD). The iPOS-R tool facilitates documentation of self-reported symptom burden, including indices of mobility and weakness. Whether these self-reported physical symptoms relate to hard endpoints or costly assisted transport to dialysis is not yet established.
Methods: This retrospective clinic audit of data from ESKD patients at Concord Hospital included all patients who completed the iPOS-R between January-March 2019. The iPOS-R captures two indices of physical impairment: ‘Poor mobility’, ‘Weakness/lack of energy’ (rated 0-4). These were compared to mode of transport to dialysis including independent (drive or public transport), supported (family driven), or dependent (taxi or ambulance).
Results: Data from 75 dialysis patients (29F:46M) with a mean age 71.7±10.4 years were analysed. Weakness/lack of energy was reported by 52/75 (68%) and poor mobility was reported by 34/75 (45%). 44/75 patients had mode of transport data. Those with mobility impairment had significantly greater use of dependent transport modes (p<0.05). 18/44 reported mobility impairment with 16% utilising independent transport (vs 54% without impairment) and 22% required ambulance transport (vs 0 without impairment). Weakness showed no relationship to transport.
Conclusions: These results demonstrate that self-reported mobility scores relate to transport modes for dialysis treatment. Poor mobility is associated with higher costs in patient management and the iPOS-R score could be used to indicate referral to Exercise Physiology services. Future studies linking iPOS-R responses to other hard endpoints such as hospitalisations and adverse events will further the clinical utility of the iPOS-R tool.
Dr Arnold is an NHMRC Early Career Fellow and lecturer in the Dept of Exercise Physiology, UNSW. She is also an Accredited Exercise Physiologist (AEP). Her research is currently focused on the role of Exercise Physiology as part of multidisciplinary care teams of dialysis and CKD patients. Her studies are working to identify pragmatic indicators for referral to exercise professionals and to work toward equitable access to allied health in this context.