Psychological Distress and Self-Management in CKD: A Cross-Sectional Study.

Rationale & Objective: Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations. Study Design: Cross-sectional online questionnaire data as part of the E-GOAL study. Setting & Participants: Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m2) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires. Exposures: Psychological distress, depressive symptoms, and anxiety symptoms. Outcomes: Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors). Analytical Approach: Adjusted multivariable regression and ordinal logistic regression analyses. Results: In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (ßadj, -0.13; 95% CI, -0.23 to -0.04), less physical activity (ßadj, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (ßadj, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07). Limitations: Cross-sectional design, possible residual confounding, and self-report. Conclusions: Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management. Plain-Language Summary: This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.

The Personalized Priority and Progress Questionnaire (PPPQ): A personalized instrument for quality of life and self-management for use in clinical trials and practice.

PURPOSE: The aim of this study was to develop and validate a brief personalized instrument that (1) defines patients' priorities for improvement, (2) measures progress in prioritized quality of life (QoL) and self-management outcomes, and (3) is applicable in both clinical practice and clinical trials. METHODS: The instrument was developed based on the literature on personalized assessment and patient priorities, feedback by clinicians, and six cognitive interviews with patients with chronic kidney disease. The resulting questionnaire, the Personalized Priority and Progress Questionnaire (PPPQ), contains a baseline and follow-op measurement. The baseline measurement assesses functioning on QoL (8 items) and self-management (5 items). The final item evaluates patients' priorities for improvement. The follow-up measurement assesses progress in QoL and self-management. A personalized progress score can be calculated indicating the amount of progress on the QoL or self-management domain that is prioritized by the individual patient. Psychometric properties of the PPPQ were evaluated among patients with chronic kidney disease (n = 121) and patients with kidney failure treated with dialysis (n = 22). RESULTS: The PPPQ showed to be a feasible instrument that is easy and quick to complete. Regarding the construct validity, small to large correlations were found between the items and existing validated questionnaires measuring related constructs. CONCLUSION: The PPPQ proved to be a feasible and valid instrument. The PPPQ can be adapted to match diverse populations and could be a useful tool both in clinical practice (e.g., to identify priorities and tailor treatment) and clinical trials (e.g., to evaluate the effectiveness of personalized interventions).

eHealth to Improve Psychological Functioning and Self-Management of People With Chronic Kidney Disease: A Randomized Controlled Trial.

OBJECTIVE: Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis ( N = 121). METHODS: Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. RESULTS: Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning ( b = 0.46, 95% confidence interval = 0.07-0.85) and self-management ( b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. CONCLUSIONS: Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments. TRIAL REGISTRATION: Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).

Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study.

BACKGROUND: Progression of chronic kidney disease (CKD) may be delayed if patients engage in healthy lifestyle behaviors. However, lifestyle adherence is very difficult and may be influenced by problems in psychosocial functioning. This qualitative study was performed to gain insights into psychosocial barriers and facilitators for lifestyle adherence among patients with CKD not receiving dialysis. METHODS: Eight semi-structured focus groups were conducted with a purposive sample of 24 patients and 23 health care professionals from four Dutch medical centers. Transcripts were analyzed using thematic analysis. Subsequently, the codes from the inductive analysis were deductively mapped onto the Theoretical Domains Framework (TDF). RESULTS: Many psychosocial barriers and facilitators for engagement in a healthy lifestyle were brought forward, such as patients' knowledge and intrinsic motivation, emotional wellbeing and psychological distress, optimism, and disease acceptance. The findings of the inductive analysis matched all fourteen domains of the TDF. The most prominent domains were 'social influences''and 'environmental context and resources', reflecting how patients' environments hinder or support engagement in a healthy lifestyle. CONCLUSIONS: The results indicate a need for tailored behavioral lifestyle interventions to support disease self-management. The TDF domains can guide development of adequate strategies to identify and target individually experienced psychosocial barriers and facilitators.

Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway.

Many patients with lifestyle-related chronic diseases find it difficult to adhere to a healthy and active lifestyle, often due to psychosocial difficulties. The aim of the current study was to develop an eHealth care pathway aimed at detecting and treating psychosocial and lifestyle-related difficulties that fits the needs and preferences of individual patients across various lifestyle-related chronic diseases. Each intervention component was developed by (1) developing initial versions based on scientific evidence and/or the Behavior Change Wheel; (2) co-creation: acquiring feedback from patients and health professionals; and (3) refining to address users' needs. In the final eHealth care pathway, patients complete brief online screening questionnaires to detect psychosocial and lifestyle-related difficulties, i.e., increased-risk profiles. Scores are visualized in personal profile charts. Patients with increased-risk profiles receive complementary questionnaires to tailor a 3-month guided web-based cognitive behavioral therapy intervention to their priorities and goals. Progress is assessed with the screening tool. This systematic development process with a theory-based framework and co-creation methods resulted in a personalized eHealth care pathway that aids patients to overcome psychosocial barriers and adopt a healthy lifestyle. Prior to implementation in healthcare, randomized controlled trials will be conducted to evaluate its cost-effectiveness and effectiveness on psychosocial, lifestyle, and health-related outcomes.

Exploring the direct or inverse association of physical activity with behavioral addictions and other self-regulation problems. / ¿Protege o predispone la actividad física a las adicciones conductuales y otros problemas de autorregulación?

This cross-sectional survey study had the aim of clarifying the relationships between leisure time physical activity (LTPA) and non-drug-re-lated self-regulation problems (non-drug-related SRPs), including behavioral addictions, and the role of impulsive personality traits therein. Spanish university students (N = 329; Mage = 21.20) completed questionnaires for each of these constructs. Fitness and Bodybuilding LTPA was negatively associated with video gaming-related SRPs, r = -.13, p = .019, 95% CI (bootstrapped) [-.23, -.02], and positively associated with sex-related SRPs, r = .16, p = .005, 95% CI (bootstrapped) [.04,  .30]. Endurance LTPA was associated with higher scores in eating-related SRPs, r = .17, p = .003, 95% CI (bootstrapped) [.02,  .31]. The proportion of participants presenting scores above the clinically significant threshold in eating-related SRPs was 2.64 times higher for respondents in an Excessive Endurance LTPA cluster compared to the other respondents, Fisher's exact test, p = .017, OR = 3.10, 95% CI [1.26, 7.63], and the proportion of participants reporting vomiting to control weight was 2.12 times higher, Fisher's exact test, p = .040, OR = 2.43, 95% CI [1.06, 5.57]. The associations were largely independent of impulsive personality traits. We identified an elevated risk of eating pathology in a subgroup of participants with anomalously high participation in endurance physical activity. This overlap is consistent with the secondary dependence hypothesis of exercise addiction.

Este estudio tuvo como objetivo aclarar las relaciones entre la actividad física de ocio (AFO) y los problemas de autorregulación (PARs) no relacionados con drogas, incluyendo las adicciones conductuales, y el papel de los rasgos de personalidad impulsiva. Estudiantes universitarios españoles (N = 329, Mage = 21,20) completaron cuestionarios para cada uno de estos constructos.La AFO de gimnasio y musculación se asoció negativamente con los PARs relacionados con videojuegos, r = -0,13, p = 0,019, 95% CI (bootstrapped) [-0,23, -0,02], y positivamente con los PARs relacionados con sexo, r = 0,16, p = 0,005, 95% CI (bootstrapped) [0,04, -0,30]. La AFO de resistencia se asoció positivamente con los PARs relacionados con la alimentación, r = 0,17, p = 0,003, 95% CI (bootstrapped) [0,02,  0,31]. La probabilidad de presentar puntuaciones potencialmente clínicas en PARs de alimentación fue 2,64 veces mayor para los encuestados en un grupo de AFO de resistencia excesiva en comparación con los otros encuestados, prueba exacta de Fisher, p = 0,017, OR = 3,10, 95% CI [1,26, 7,63], y la probabilidad de vomitar para controlar el peso fue 2,12 veces mayor en ese mismo grupo, prueba exacta de Fisher, p = 0,040, OR = 2,43, 95% CI [1,06, 5,57]. Las asociaciones fueron en gran medida independientes de los rasgos de personalidad impulsiva.Identificamos un riesgo elevado de patología alimentaria potencialmente clínica en un subgrupo de participantes con niveles anormalmente altos de actividad física de resistencia. Esta superposición es consistente con la hipótesis de dependencia secundaria en la adicción al ejercicio.

¿Protege o predispone la actividad física a las adicciones conductuales y otros problemas de autorregulación? / Exploring the direct or inverse association of physical activity with behavioral addictions and other self-regulation problems

Este estudio tuvo como objetivo aclarar las relaciones entre la actividad física de ocio (AFO) y los problemas de autorregulación (PARs) no relacionados con drogas, incluyendo las adicciones conductuales, y el papel de los rasgos de personalidad impulsiva. Estudiantes universitarios españoles (N = 329, Mage = 21,20) completaron cuestionarios para cada uno de estos constructos. La AFO de gimnasio y musculación se asoció negativamente con los PARs relacionados con videojuegos, r = -0,13, p = 0,019, 95% CI (bootstrapped) [-0,23, -0,02], y positivamente con los PARs relacionados con sexo, r = 0,16, p = 0,005, 95% CI (bootstrapped) [0,04, -0,30]. La AFO de resistencia se asoció positivamente con los PARs relacionados con la alimentación, r = 0,17, p = 0,003, 95% CI (bootstrapped) [0,02, 0,31]. La probabilidad de presentar puntuaciones potencialmente clínicas en PARs de alimentación fue 2,64 veces mayor para los encuestados en un grupo de AFO de resistencia excesiva en comparación con los otros encuestados, prueba exacta de Fisher, p = 0,017, OR = 3,10, 95% CI [1,26, 7,63], y la probabilidad de vomitar para controlar el peso fue 2,12 veces mayor en ese mismo grupo, prueba exacta de Fisher, p = 0,040, OR = 2,43, 95% CI [1,06, 5,57]. Las asociaciones fueron en gran medida independientes de los rasgos de personalidad impulsiva. Identificamos un riesgo elevado de patología alimentaria potencialmente clínica en un subgrupo de participantes con niveles anormalmente altos de actividad física de resistencia. Esta superposición es consistente con la hipótesis de dependencia secundaria en la adicción

This cross-sectional survey study had the aim of clarifying the relationships between leisure time physical activity (LTPA) and non-drugrelated self-regulation problems (non-drug-related SRPs), including behavioral addictions, and the role of impulsive personality traits therein. Spanish university students (N = 329; Mage = 21.20) completed questionnaires for each of these constructs. Fitness and Bodybuilding LTPA was negatively associated with video gaming-related SRPs, r = -.13, p = .019, 95% CI (bootstrapped) [-.23, -.02], and positively associated with sex-related SRPs, r = .16, p = .005, 95% CI (bootstrapped) [.04, .30]. Endurance LTPA was associated with higher scores in eating-related SRPs, r = .17, p = .003, 95% CI (bootstrapped) [.02, .31]. The proportion of participants presenting scores above the clinically significant threshold in eating-related SRPs was 2.64 times higher for respondents in an Excessive Endurance LTPA cluster compared to the other respondents, Fisher’s exact test, p = .017, OR = 3.10, 95% CI [1.26, 7.63], and the proportion of participants reporting vomiting to control weight was 2.12 times higher, Fisher’s exact test, p = .040, OR = 2.43, 95% CI [1.06, 5.57]. The associations were largely independent of impulsive personality traits. We identified an elevated risk of eating pathology in a subgroup of participants with anomalously high participation in endurance physical activity. This overlap is consistent with the secondary dependence hypothesis of exercise addiction