EVALUATE THE EFFECT OF INTRADIALYTIC STRETCHING EXERCISE ON MUSCLE CRAMPS AMONG PATIENTS UNDERGOING HAEMODIALYSIS

Abstract

Background: Chronic kidney disease is common and many patients in Pakistan depend on regular hemodialysis to stay alive, but muscle cramps during treatment are still a very frustrating problem for them. These cramps tend to affect the lower legs, interfere with dialysis and slowly erode the patient's quality of life despite good dialysis blood markers. Objective: The aim of this research was to compare muscle cramps and health related quality of life changes in the group of patients receiving maintenance hemodialysis training with the use of intradialytic stretching exercises vs. the control group. Methods: In total about four months, a quasi experimental two group pre test post test design was employed in three dialysis units in Lahore. Adult patients on maintenance hemodialysis who reported cramps were recruited by consecutive non probability sampling, and then allocated to a study group (n = 27) and a control group (n = 27). The study group was given guided intradialytic leg and foot stretching for approximately 8-10 minutes a session for three weeks, and the control group was given regular care without stretching. The severity of muscle cramp was scored on a numeric rating scale and the quality of life was rated by the WHOQOL BREF. The analysed data in SPSS 27 at p < .05. Results: The mean age was approximately 47 years, most were of average body weight and mean Kt/V was about 1.38. The most common causes of end stage renal disease (ESRD) were diabetes (66.6%) and hypertension (33.4%) and there was a significant relationship between primary cause and cramp severity (χ² = 23.79, p = .022). Muscle cramps were more likely to happen during dialysis (63 percent) and were focused in the lower limbs, especially the legs (29.6 percent) and calves (27.8 percent). Mean WHOQOL BREF scores decreased from baseline to end point (58.98 to 47.59) and remained low and almost unchanged in the study group (69.67 to 48.22); whereas the control group did not change. Age was negatively correlated with end point scores (r = −.325, p = .016) and positively correlated with weight (r = .312, p = .022) and baseline and end point scores were highly correlated (r = .614, p < .001) indicating that older and lighter patients were particularly susceptible to lower scores. Conclusion: Intradialytic muscle cramps were very common and mainly occurred in the lower limbs and correlated with lower and declining quality of life scores among older and lighter patients