Author: Lee, Mi Suen Connie
Title: Application of virtual reality for peritoneal dialysis exchange learning in patients with end-stage renal disease and cognitive impairment
Advisors: Fong, Kenneth (RS)
Degree: DHSc
Year: 2022
Subject: Peritoneal dialysis
Kidneys -- Diseases -- Treatment
Virtual reality in medicine
Cognition disorders -- Patients -- Rehabilitation
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: x, 103 pages : color illustrations
Language: English
Abstract: There is an increasing number of people with rising age suffers from end stage renal disease (ESRD) in Hong Kong. Patients with ESRD will receive renal replacement therapy (RRT) including peritoneal dialysis (PD), haemodialysis (HD) and renal transplant (Tx). As Hong Kong implements "PD-first" policy, more than 80% of ESRD patients requiring dialysis are put on PD, and among which 86% are on continuous ambulatory peritoneal dialysis (CAPD) while the remaining are using automated peritoneal dialysis (APD). Cognitive impairment is not uncommon in patients with ESRD, and could affect dialysate exchange techniques leading to adverse outcomes such as peritonitis in patients on PD. PD exchange is a complex procedure that demands knowledge and skill. Real task practice is labour-intensive, since it requires close supervision and guidance by a renal nurse specialist. In this study, a non-immersive virtual reality (VR) training program through Leap motion hand tracking device was developed to facilitate patients' understanding and learning of PD exchange procedure before real task practice. This study was a two-centre single blinded randomized controlled trial, the primary outcome measures which evaluate patient's knowledge and proficiency towards PD exchange and confidence in self-administer PD exchange were PD knowledge test, PD steps sequence test through the VR program, Chinese-General Self Efficacy (Chinese-GSE) and four self-constructed supplementary questions on confidence towards carry out PD exchange, and PD technique assessment conducted by renal nurse. The secondary outcomes that measure cognitive function of patient were Rivermead Behavioual Memory Test – Version 3 (RBMT-3) and Wisconsin Card Sorting Test – Computer version 4 (WCST-CV4). For the experimental group, a patient satisfaction survey on their perceptions of usefulness and preference of using VR training in learning PD exchange was also conducted.
A total of 23 patients were recruited. Twelve patients in the experimental group received 8 to 10 sessions of VR training, while 11 patients in the control group were given with printed educational materials. Both groups of patient then received a one-week CAPD training at day centre where real PD exchange procedure was educated by a renal nurse specialist before discharge. Pre-treatment and post-treatment data were collected. Repeated measure analysis of covariance (RANCOVA) was used to analyse the within-subject effect and the between-subject effect on the outcome measurements. Results showed that there were between-group effects in total correct response in PD step sequence (F=4.59, p<0.05), with favorable impact on knowledge and skill in the PD exchange sequence especially the crucial steps that are critical to minimize peritonitis. Moreover, 89% of the participants in the experimental group were satisfied with using the VR training and all patients liked it to be incorporated in PD exchange learning. We concluded that VR can be a useful aid in the training and reinforcement of PD exchange procedures.
Rights: All rights reserved
Access: restricted access

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