Renal rehabilitation: Obstacles, progress, and prospects for the future

The definition of rehabilitation for end-stage renal disease (ESRD) patient s has changed significantly over the past 40 years. Initially, the concept focused on return to employment. In the early days, most members of the sma ll select group of patients chosen for dialysis met this criterion and were considered successfully rehabilitated. However, this "success" could not b e replicated in the broader ESRD population when Medicare coverage was expa nded to include older and more debilitated patients. This raised serious qu estions about the feasibility of renal rehabilitation efforts. Government p olicy makers and the nephrology community responded by (1) gathering data t o enable the measurement and improvement of health-related quality of care, and (2) redefining rehabilitation and its goals. Today, renal rehabilitati on is defined broadly, in terms of optimal functioning for individual patie nts and restoration to productive activities-not simply employment. To fost er renal rehabilitation and guide program development, the Life Options Reh abilitation Advisory Council (LORAC) identified five core principles, calle d the "5 E's"-Encouragement, Education, Exercise, Employment, and Evaluatio n. Considerable progress has been made in measuring outcomes of care and in establishing a connection between rehabilitation interventions and improve d outcomes. Increasingly, research is focused on the relationship between p atient self-reports and health status outcomes. In the years ahead, clinici ans and researchers will see growing evidence of relationships between spec ific rehabilitation interventions, improved outcomes (including health-rela ted quality of life), and cost-effective delivery of care. (C) 2000 by the National Kidney Foundation, Inc.