Bourne L. Auguste|Abdullah Al?Muhaiteeb|Christopher T. Chan
The Effect of Learning Styles on Adverse Events in Home Hemodialysis Patients
University Health Network|University Health Network|University Health Network
better clinical outcomes home hemodialysis hd led significant growth seen last two decades augmenting frequency duration dialysis home hd improves bp control reduces left ventricular hypertrophy enhances middle molecular clearance 12 however hd training technical complexity adverse event risk pose significant challenges wider adoption serious adverse event rates home hd recently reported 006 events per 1000 dialysis treatments 3 patients home hd diverse educational experiences learning styles vark validated questionnaire examines individuals preferred learning preferences 45 individuals following visual v auditory readingwriting r kinesthetic k one learning preference referred unimodal two referred bimodal two referred multimodal instance someone nonv bimodal learner following combinations ar ak rk questionnaire results help individualize instruction enhancing educational experiences learners 4 similarly tailoring training learning styles patients home hd important tool may improve knowledge retention patient outcomes current instructional methods including institution individualized training ranges 812 weeks includes instructional videos manuals supported handson teaching 11 nursing care instructions cover basic concepts dialysis focusing troubleshooting vascular access problems completing training patients must pass written examinations interrogate ones understanding concepts related access complications given strong v content current material hypothesized v learners institution better outcomes 6month period initial home hd training compared nonv learners conducted observational study examining adverse events individual learning preferences using vark questionnaire version 78 among 61 adult patients prevalent home hd trained january 1 1997 december 31 2016 toronto general hospital toronto canada patients completed questionnaires march 2016 2017 observed 6 months received research ethics approval study university healthy network research ethics board 165144ae enrolled patients provided informed consent participate study electronic medical records reviewed demographic clinical data related hospital admissions dialysis vintage complications found significant differences v nonv learners age sex vascular access diabetes smoking prior kidney replacement therapy training duration health literacy identified 26 nonv 35 v patients table 1 table 1 likelihood adverse event across different learning styles learning style patients n age yr meansd training meansd patients adverse event b patients adverse event unadjusted c adjusted c v v learners vark var vak vrk vk vr v 35 57 4711 579396 18 51 nonv learners ark ar ak k r rk 26 43 5214 606314 20 77 413 117 1452 649 142 2961 p003 p002 learners vark var vak ark ar ak 38 62 5012 545367 24 63 nona learners vrk vr vk rk r k 23 38 4814 668343 14 61 147 047 464 217 056 832 p051 p026 r r learners vark var vrk ark vr ar rk r 44 72 5012 580387 28 64 nonr learners vak vk ak v k 17 23 4813 619291 10 59 112 033 380 141 035 573 p086 p063 k k learners vark vak vrk ark ak vk rk k 47 77 4913 600375 31 66 nonk learners var vr ar v r 14 23 5211 561320 7 50 076 022 270 096 022 410 p066 p095 p value 005 indicates statistical significance odds ratio v visual auditory r readingwriting k kinestheticaadverse events predominantly bacteremia related access approximately 555 patients access clotting needle dislodgement catheter damage accounting approximately 10 patients air embolism requiring hospitalization one patientbadverse events included vascular access complications bacteremia dialysisrelated events required hospitalization since starting home hemodialysiscor comparing likelihood single adverse event patient within different subgroups reference groups ors v r k learnersdadjusted access type duration training days diabetes dialysis vintage visual impairment auditory impairment peripheral neuropathy adverse events defined arteriovenous fistula graft needle dislodgement accessrelated thrombosis damage central venous catheter air embolism symptoms dialysis requiring hospitalization bacteremia primary outcome interest adverse events occurring start home hd 6 months study enrolment considered deaths study period average age 4912 years old 32 patients men adverse event rate groups 008 events per patientyear 77 nonv learners least one adverse event compared 51 v learners additionally nonv learners four times likely single adverse event compared v learners adjustment likelihood increased 65 times 649 95 confidence interval 142 2961 p002 table 1 nona groups showed trend toward adverse events whereas strong trends seen r k groups pilot study show different learning styles patients home hd exist associated adverse events although results show higher likelihood adverse events nonv learners one particular learning style considered maladaptive rather highlights potential areas enhance quality training currently rendered adverse events may prevalent instructional method home hd training patient learning styles incongruent novel findings illustrate differences learning styles exist considered patient training major study limitations include following 1 vark evaluates one aspect learning factor personality motivation traits 2 lack validation studies vark dialysis populations 3 small singlecenter observational study limited event rate 4 uncertainty interaction different learning styles 5 captured bacteremia adverse events possibly introducing overestimation effect findings 6 long home hd vintage possibly allowed learning adaptations certain individuals years despite limitations vark provides insightful information learning style differences exist home hd grows patients tasked performing complex procedures home ensuring knowledge conveyed format suits individual learning preferences pivotal vark questionnaires may identify learners risk consequently areas deficiency current instructional methods future multicenter studies comparing learning styles instructional method adverse event rates confirm preliminary findings required disclosures none