Multidimensional Assessment of Physical Function for People in Dialysis: The Rehabilitation in Hemodialysis Area Centro Toscana (REACT) Study

Background: Physical performance is poorly addressed indialysis patients, due to several clinical and organizational barriers. In this study we investigated the physicalfunctional status of a cohort of dialysis patients, using amultidimensional assessment. Methods: Four hundredand forty-six individuals from 8 hemodialysis centers(176 females), mean age 67.5 ± 14.1 years, and dialysisvintage 62 ± 72.1 months, were assessed by a multidimensional battery including Short Form Health Survey(SF12), Elderly Falls Screening Test (EFST), Short PhysicalPerformance Battery (SPPB), and Handgrip Strength Test(HST). Individuals were stratified into 3 groups (poor,moderate, and good performers) according to the SPPBscore. Functional assessments were performed by staffnurses, with the support of physiotherapists and nephrologists. Results: According to SPPB, 53.4% of dialysispatients showed a severe physical impairment. A significant difference emerged among the 3 SPPB groupsfor age, HST, EFST, and SF12. The main predictors of theSPPB score group were age (p = 0.0001), EFST (p = 0.028moderate performers and p = 0.0001 poor performers),dominant HST (p = 0.04 moderate performers), and SF12physical (p = 0.003 moderate performers and p = 0.0001poor performers). Each age group showed physicalperformance comparable to a healthy general population of 10 years older. Conclusions: Our resultsconfirmed the severe impairment of physical function inthe end stage kidney disease population. The multidimensional assessment showed that SPPB test is an effective tool to stratify the dialysis population. Moreover,EFST, HST, and SF12 may contribute to the definition of atailored physical activity program based on patientcharacteristics.