What is the clinical evidence from this study?

Study design: Other. Population: Orthostatic hypotension in hemodialysis patients (n=40). Intervention: Leg crossing vs. Standing without leg crossing. Primary outcome: Systolic blood pressure in standing position (p=0.006).

December 31, 2015Open Access

The Effect of Leg Crossing on Reducing Orthostatic Hypotension in Hemodialysis Patients

SKSi Sook Kim KCKyung Sook ChoiUniversity of Wisconsin–Green Bay SWSam WonDaejeon Sun Hospital

Key Result

Leg crossing significantly increased standing systolic blood pressure (128.7 vs 122.6 mmHg, p=0.006) in hemodialysis patients, though it did not significantly reduce subjective orthostatic symptoms.

Structured PICO

Does standing with leg crossing improve blood pressure and reduce orthostatic hypotension symptoms in post-hemodialysis adult patients?

Population

40 adult patients (mean age 59.4, 42.5% female) on stable hemodialysis for over 3 months, evaluated for orthostatic hypotension before and after a leg crossing maneuver.

Intervention

Standing with leg crossing position

Comparator

Standing without leg crossing position (pretest baseline)

Outcome

Blood pressure (systolic, diastolic, mean arterial pressure) and heart rate in standing positionsurrogate

Leg crossing is a simple, cost-free physical maneuver that significantly improves standing blood pressure in post-hemodialysis patients, though it may not immediately relieve orthostatic symptoms.

Main Result

Absolute Event Rate: 128.7% vs 122.6%

p-value: p=0.006

Limitations

Single-group pretest-posttest design without a control group or randomization.
Difficulty controlling extraneous variables affecting orthostatic hypotension in patients with various complications.
Exclusion of patients with intradialysis hypotension or balance issues limits generalizability.
Short-term evaluation of the intervention's effect.

Abstract

Purpose: The purpose of this study is to examine the effect of leg crossing on reducing orthostatic hypotension and orthostatic hypotension symptoms in hemodialysis patients. Methods: A one-group pretest-posttest design was used. A total of 40 post-hemodialysis adult patients were enrolled, excluding the case of intradialysis hypotension, unbalance of standing with leg crossing, adding antihypertensive medications. Blood pressure (BP) and heart rate (HR) were measured in supine and standing positions. After a week, BP and HR were measured in supine and standing with leg crossing position. Orthostatic hypotension symptoms were also measured by self-reported structured questionnaire in standing without leg crossing and with leg crossing position. Results: We found out that systolic blood pressure, diastolic blood pressure, and mean arterial pressure increased significantly in standing with crossing leg position applied (p=.006, p=.001, p=.006). However, presences of orthostatic hypotension symptoms were not significantly decreased in standing with leg crossing position (p=.500, p=.318, p=.306, p=.241, p=.356, p=.500, p=.241, p=.308). Conclusion: This study shows that leg crossing is effective for reducing orthostatic hypotension without additional cost or instruments. Leg crossing as one of the preventive interventions to reduce orthostatic hypotension is easier and simpler to be implemented in hemodialysis patients.

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