Observational Study of an Arts-in-Medicine Program in an Outpatient Hemodialysis Unit

Division of Nephrology, Hypertension & Renal Transplantation, University of Florida, Gainesville, Florida, United States
American Journal of Kidney Diseases (Impact Factor: 5.9). 03/2006; 47(3):462-8. DOI: 10.1053/j.ajkd.2005.11.030
Source: PubMed


Long-term hemodialysis is associated with impaired quality of life (QOL) and depression, which are thought to worsen compliance with the treatment regimen. With the success of our hospital's Arts-in-Medicine Program, we launched a similar set of activities in the long-term dialysis unit and sought to measure their effects.
At baseline and 6 months, we administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Beck depression scales to 46 patients (44% men; mean age, 52 years) and assessed their percentage of achieved dialysis time, interdialytic weight gain, and predialysis laboratory results. We tested for a relationship between these variables and Arts-in-Medicine Program participation (low and high; 51% and 49%). Arts in Medicine was offered each shift, led by artists, and included artwork, crocheting, crafts, seasonal displays, poetry, and playing musical instruments.
At 6 months, the patients, nurses, technicians, and physicians subjectively believed that Arts in Medicine had a positive impact on the unit. In paired comparisons to baseline, there was significant improvement in SF-36 scores for Role-Physical (mean values, 34.4 to 38.7; P = 0.04), less weight gain (3.6 to 3.2 kg; P = 0.02), greater serum carbon dioxide content (20.4 to 22.5 mEq/L [mmol/L]; P < 0.01), greater phosphate levels (5.3 to 5.7 mg/dL [1.71 to 1.84 mmol/L]; P = 0.04), and a trend to less depression (Beck score, 15.3 to 12.1; P = 0.07). Regression analyses showed that high participation correlated with improved SF-36 scores for Social Function (11.1-unit increase; P = 0.01), Bodily Pain (7.6-unit increase; P = 0.04), and Role-Physical (6.6-unit increase; P = 0.06), as well as a trend to greater albumin levels (0.11 g/dL [1.1 g/L]; P = 0.08), but with greater phosphate (0.8 mg/dL [0.26 mmol/L]; P = 0.01) and lower calcium levels (0.3 mg/dL [0.07 mmol/L]; P = 0.07).
Participation in a new Arts-in-Medicine Program correlated with improved QOL measures, and there were encouraging trends for depression, as well as certain laboratory and hemodialysis parameters.

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    ABSTRACT: Purpose The SF-36, a generic measure of 8 domains of health-related quality of life (HRQOL), has been widely used to examine HRQOL of end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). The current study synthesizes existing literature to examine which SF-36 domains capture the largest burden in this patient population. Methods A literature search of published studies that presented descriptive statistics for baseline SF-36 scale scores from HD patients was conducted. Disease burden was estimated by comparing HD patients’ SF-36 scores to those from either a control group or a general population normative sample taken from the same country. For each study, Cohen d effect sizes for between-sample differences were calculated for each scale. Results Twenty-six articles that matched set criteria were identified. Estimation of differences between HD patients and comparison groups showed that the SF-36 physical functioning scale yielded the largest weighted mean effect size across studies (d = 1.46), followed by the general health (d = 1.29) and role physical (d = 1.21) scales. Conclusions Among the eight domains of the SF-36, physical functioning, general health, and role physical scales best captured disease burden for HD patients. The disease burden negatively impacts physical HRQOL more strongly than mental HRQOL.
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