A digital solution to provide physical and emotional wellbeing for renal patients across the UK

Physical activity levels for renal patients are low, with high levels of sedentary behaviour. Both behaviours can be changed with appropriate support.

It is increasingly acknowledged that effective rehabilitation delivers better outcomes and improved quality of life. It has the potential to reduce health inequalities and make significant cost savings across the health and care system.

King's College Hospital NHS Foundation Trust (KCH) is one of the largest renal centres in London and is one of the only three renal centres in England that provides a locally commissioned renal rehabilitation programme. There is a real need to address the inequality in provision of routine rehabilitation for this patient population, including investigating digital solutions.

Situation

During the first COVID-19 lockdown, the team at KCH could no longer provide face-to-face rehabilitation for people living with kidney disease, and it became apparent that there were many patients whose emotional and physical wellbeing was being negatively affected by the requirement for them to shield at home.

Aspiration

The department wanted to:

• digitise the way they could support patients with physical and emotional wellbeing remotely
• empower patients to manage their health and wellbeing
• provide a remote service to people not routinely offered physical rehabilitation across the UK

Solution and impact

KCH partnered with Kidney Beam, an online exercise platform, to explore how technology can help people living with kidney disease manage their physical and emotional wellbeing remotely during COVID-19 and beyond.

The website offers live and on-demand movement classes, and behaviour change support tools to increase physical activity, as well as tools to improve mood and manage negative emotions associated with having kidney disease. The digital delivery of the intervention allows the provision of a theoretically informed, evidence-based physical and emotional wellbeing programme to be delivered across the UK, free at the point of contact, at a low cost to the provider and funder.

Kidney Beam is suitable for patients at all stages of the kidney disease pathway; including pre-dialysis, dialysis, transplantation and supportive care.

It is also important for those with risk factors like:

• diabetes
• hypertension

Impact

There was user testing with health care professionals and patients, alongside collection of feasibility data, during a 6-month project. There were 959 sign-ups to the platform in the 6-month period.

A pre-post survey revealed:

• 67% increase in patients reporting that they were meeting the physical activity recommendation of 150 minutes or more of moderate activity per week
• 20% increase in patients reporting 75 mins or more of vigorous activity per week
• 74% increase in patients reporting the recommendation of twice weekly strength training by the end of the 6-month project
• an increase of 67% of patients who perceived their energy levels to be good or very good
• more than 1900 movement classes were completed during the 6 months, with a total of 60,000 movement minutes

Kidney Beam has been implemented successfully in the UK health and social care system over the last 18 months. In brief, there have been 2200 sign-ups to the Kidney Beam platform, of which 1515 are people living with a kidney condition.

A randomised controlled trial is underway to evaluate clinical value and cost-effectiveness of the Kidney Beam programme delivered as part of clinical care in the UK (NCT04872933).

A national implementation project is also underway via the Renal Clinical Networks.

Functionality

• The platform offers live and on-demand movement classes, and behaviour change support tools to increase physical activity, as well as tools to improve mood and manage negative emotions associated with having kidney disease.
• Users can access live and on-demand movement classes, educational videos, schedule activities, send themselves reminders, record off-platform activity and monitor their physical activity against recommended weekly physical activity targets.
• Engagement with the website is encouraged through regular email updates, self-monitoring of behaviour, prompts/cues, and newsletters.
• The team is continuing to look at more ways they can benefit from interfacing with other digital health solutions. This includes work to interface with Patients Know Best (PKB).

Capabilities

• Since the implementation of Kidney Beam, there is improved access to physical and emotional rehabilitation for people living with kidney disease across the UK.
• Renal teams are better placed to support patients in the self-management of their renal condition, and their physical and emotional wellbeing.
• Patients can assess their own level of physical function and can contact the team for advice if they are concerned.
• Allows for much better self-care and the first opportunity for routine delivery of physical and emotional wellbeing for this patient population.

Scope

• Kidney Beam is a platform for patients to access at home.

Key learning points

• It is easy for patients to sign up to the service and there is technical support from the team for those needing extra help.
• Where possible, in face-to-face clinics the platform was demonstrated to patients and they were supported to register there and then.
• Patients reported Kidney Beam was simple to navigate and use.
• Patients were more likely to sign up and complete a class if they were recommended to do so by their clinical team.

Digital equalities

• Development followed best practice for ensuring accessibility to people with low literacy / health literacy skills, including use of video and personal stories, and following national guidelines to ensure the text was suitable for those with poor vision and appropriate for an ethnically diverse kidney population.
• The Kidney Beam team has an arrangement with Citizens Online, a charity who assists people with digital technology, aiming to reduce the digital divide in the UK. They also support people to use Microsoft ‘Edge Translate’, a digital translation tool that translates web pages into 60 different languages including Spanish, French, Chinese, Gujarati, Hindi, and Urdu.
• The on-demand function allows access to classes at a time suitable to the patient, including being able to access classes in out of work hours.
• Kidney Beam can be accessed through any digital device, including any smartphone.

Key figures and quotes

• Pilot data showed a 67% increase in patients doing 150 minutes of moderate physical activity per week.
• 20% increase in patients doing strength training.
• 95% of patients would recommend Kidney Beam.

“Prior to being on Kidney Beam, I was folding in on myself, but kidney beam put a whole new perspective on my being home alone. Initially it seemed like a chore, but now it’s the one thing that I really look forward to. It’s the reason why I want to wake up, get out of bed and get ready in the mornings. I also enjoyed the emails, on what’s happening in the kidney world. Kidney Beam perked me up, made me smile, made me want to keep up the fight against this awful condition.”

Mary, Kidney Beam Service User

“Beam is an excellent way to exercise at home. The instructors have in depth knowledge of the conditions users have which installs confidence. I can be sure that I am not exercising in a way that could be potentially harmful. Beam has been a perfect way for me to regain fitness and strength following my transplant last year.”

Jon, Kidney Beam Service User

“This is a fabulous initiative for kidney patients, carers and even the staff looking after them. I love the focus on living well as opposed to living with illness. Huge congratulations to all the team and funders who’ve made this possible.”

Professor Liz Lightstone PhD FRCP, Imperial College London

“Kidney Beam is an ideal way to become active at home, at any time. The UK Kidney Association and Association of Nephrology Nurses UK fully endorse and support this programme. Share with colleagues and patients and keep well, healthy and active.”

Karen Jenkins, President of The Association of Nephrology Nurses UK and Vice President of The UK Kidney Association

Find out more

The Renal Association Clinical Practice Guideline: Exercise and lifestyle in chronic kidney disease

Key contact

Dr Sharlene Greenwood, Consultant Renal Physiotherapist, King's College Hospital NHS Foundation Trust sharlene.greenwood@nhs.net