J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, pp.

2129, 2012

EASE

Effects of the EASE Program in Chronic Kidney Disease Education:

A Randomized Controlled Trial to Evaluate Self-Management

1, 2 3 2 4
5 5 5 6
Hiroko Joboshi, Michiyo Oka, Satsuki Takahashi, Hiromi Onbe, Yukiko Hara,
Chiemi Murase, Miho Chaen, Yoshiko Miyashita, Naomi Kakimoto

Key wordschronic kidney disease, patient education, self-management, randomized controlled trial

Abstract

PurposeWe performed intervention using the EASE program in a non-blind randomized con-
trolled trial in patients with chronic kidney diseaseCKD, and evaluated its effects on mean blood
pressure and blood pressure measurement rate, self-management behavior and perceived self-effi-
cacy.
MethodsIn the intervention groupn19, intervention using the EASE program was per-
formed for 12 weeks. The control groupn12received conventional education. The parameters
of intervention effects were the mean blood pressure and blood pressure measurement rate during
every 4-week period and self-management behavior, perceived self-efficacy.
ResultsNo significant difference was observed in the effect parameters between the two groups.
However, in the intervention group, self-management behavior significantly improved after inter-
vention. The median value of perceived self-efficacy increased in the intervention group but de-
creased in the control group. The blood pressure measurement rate significantly decreased during
the period after 912 weeks compared with the period after 14 weeks in both groups, and the
decrease was marked in the control group.
ConclusionA randomized controlled trial showed no significant difference in the effect param-
eters. However, in the intervention group, self-management behavior significantly improved after
intervention. EASE program has therefore been shown to be effective self-management behavior.

2011 2 28 2011 10 12
1Department of Nursing, Faculty of Health Care, Kiryu University 2
Gunma University, Graduate School of Health Sciences3School of Nursing, Faculty of
Nursing, Gunma Prefectural College of Health Sciences4Toyama College of Welfare Science5
Shinseikai Daiichi Hospital6Kohka Public Hospital

E-mailjoboshi-hi@kiryu-u.ac.jp

J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, 2012 21



CKD EASE

n 19 EASE 12 n 12
4

2

1 4 9 12


EASE

ProgramEASE
Bandura19771985
CKDchronic kidney disease 19951998

ESRDend-stage renal disease Cox1982Pender1996
CVDcardiovascular disease 1997ab
88.6%
18.720 GFR 60 ml/
min/1.73 m2 2008 2008

ESRD CVD Sagawa et al.20012003
EASE
Nozaki et
CKD 1995 al.2005
National Kidney FoundationNKF
CKD
CKD 2008

2007
CKD
CKD

Baraz et al.2010

ESRD Chow & Wong2010

QOLWong
et al.2009


2009 12
Moriyama et al.2009

EASE Encourage Autonomous Self-Enrichment CKD

22 32 1 2012
 EASE

Yamagata et al.2010
CKD



CKD
EASE




EASE

1
EASE
EASE DVD
2008
CKD
20 6 EASE
1 12
Step1 4 1
3 2 1
6 3 7 1



2008 Step 1

2


t 5


80 28
2 65 Step 2
2


EASE


3 cue
Step 3 Step
EASE 2
EASE

J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, 2012 23


CKD
2007
12
2
Step 4 2
3 2
5 1
1 14

2008

5 14 70

2008
12
2008

2008
1996
Step 5 24
4 24 96


Step 6 5
EASE 1 4
5 8 9 12 4
2
1 2 12 168
4 4 2

CKD
1/CreGFR Wilcoxon
MannWhitney U
CKD intention to treatITT
2004
CKD
2007 SPSS16.0 5

6



2003

2
1
1 2

1 2 12

24 32 1 2012
 EASE

15 3
19 4
1 1 12 10
1
8 35 1 67.68 12.07
20 38 85 73.17 8.07
1 50 86 CKD

1

2
15
16
12 38.86
11.4
3
1

3 5
7

5.0 1.4
1 mean SD

1
31 19 12
meanSD meanSD meanSD
% % %
69.8110.89 67.6812.07 73.178.07 0.176a
38 86 38 85 50 86
1858.1 1052.6 866.7 0.484b
1341.9 947.4 433.3
1754.8 1052.6 758.3 0.716b
1445.2 947.4 541.7
CKD 2 3 9.7 315.8 0 0.0 0.467c
3 1341.9 842.1 541.7
4 722.6 315.8 433.3
5 825.8 526.3 325.0
2787.1 1684.2 1191.7 1.000b
412.9 315.8 1 8.3
825.8 526.3 325.0 1.000b
2374.2 1473.7 975.0
BUNmg/dl 32.5817.43 30.9417.1 35.1918.48 0.517a
Crmg/dl 2.251.61 2.201.8 2.321.27 0.840a
KmEq/l 4.590.54 4.570.6 4.600.51 0.841a
1 Cr 0.680.44 0.730.5 0.600.39 0.842a
eGFR 34.0023.47 37.3526.7 28.6916.88 0.843a
c 2 %
a meanSDbFisher %

J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, 2012 25

 2
19 12

2 2
1 4 5 8 9 12 2

135.7819.38 135.5618.28 135.3518.29 1.148 0.293 0.038 0.022 0.979 0.001 0.143 0.867 0.005
141.6714.81 142.3512.93 142.3813.79

74.298.59 75.058.04 74.258.27 0.550 0.464 0.019 0.082 0.922 0.003 0.136 0.873 0.005
72.487.22 72.486.96 72.687.33

129.5316.47 130.1613.29 131.0513.75 1.832 0.186 0.059 0.853 0.432 0.029 0.511 0.602 0.017
136.8318.39 128.9716.37 137.6116.31

71.069.01 70.626.68 70.626.99 0.222 0.641 0.008 0.118 0.889 0.004 0.193 0.825 0.007
69.56.58 70.025.28 69.316.58
2 meanSD

3
19 12

1 4 a 5 8 b 9 12 c 2 2 2
93.57.7 95.66.6 85.727.8
3.376 0.076 0.104 7.730 0.010 0.210 1.975 0.148 0.640 a
b
c
89.020.2 81.830.9 62.646.7
2 meanSD

3
2
p 0.007
1 p 0.039

p 0.034
4
83.00
1 4 93.5
2 7.40mean SD 84.0 12
7.7mean SD
%5 8 95.6 6.6%9 12 84.36 8.44 87.0
85.7 27.8% 89.0 83.25 10.16 85.0
20.2%81.8 30.9%62.6 46.7% 12 83.50 9.06 84.0
1 4 9 12
4

p0.011 5


3
p 0.034


2
4EASE
53.95 8.80mean SD
EASE 19 4
56.42 7.48 p 0.039 4 1 12
5

26 32 1 2012
 EASE

4
19 12

meanSD range meanSD range

53.958.80 3165 57.00 56.427.48 3866 58.00 2.065 0.039

54.757.82 3669 54.00 57.255.87 5269 54.00 1.261 0.207

83.007.40 7095 84.00 84.368.44 6794 87.00 0.692 0.489

83.2510.16 6194 85.00 83.509.06 6193 84.00 0.135 0.892
Wilcoxon

5
19 12

57.0 308.0 54.0 188.0 111.0 0.163 0.871

58.0 311.5 54.0 184.0 106.5 0.305 0.760

84.0 294.0 85.0 202.0 104.0 0.407 0.684

87.0 310.5 84.0 185.5 107.5 0.264 0.792
MannWhitney U

3 6

EASE

EASE

1
CKD 2

4
CKD
EASE

1 4

J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, 2012 27





4 EASE
2

EASE
2008 12

2 3
CKD 1 1
3
2
3 12 6 HbA1c
Moriyama et al.2009




12












Cox1982
90.3
83.25
10.16 83.0 7.40
EASE
4
Bandura1997
EASE

12 EASE


4

EASE

28 32 1 2012
 EASE

CKD66 9 16571663
Moriyama M., Nakano M., Kuroe Y., et al.2009: Efficacy
of a self-management education program for people

with type 2 diabetes: Results of a 12 month trial, J. J.
Nurs. Sci., 61, 5163.
2003

Cr eGFR

20044142
CKD
2007 CKD 1 3
5961

2009

3 2 2026
Nozaki C., Oka M., Chaboyer W.2005: The effects of a
cognitive behavioural therapy programme for self-care
CKD on haemodialysis patients, Int. J. Nurs. Pract., 115,
EASE 228236.
1997a
113 1216671672
2
1997b
213 1317971802
2008 EASE

1
2 1416

2008 EASE
EASE

1028085

Pender N.1996: Health Promotion in Nursing Practice

3rd ed., Applenton & Lange, Connecticut.
21

Sagawa M., Oka M., Chaboyer W., et al.2001: Cognitive

behavioral therapy for fluid control in haemodialysis
patients, Nephrol. Nurs. J., 281, 3739.
Sagawa M., Oka M., Chaboyer W., et al.2003: The utility

of cognitive behavioural therapy on chronic haemodial-
Bandura A. 1997: Self-efficacy toward a unifying of ysis patientsfluid intake, a preliminary examination,
behavioral change, Psychol. Rev., 842, 191215. Int. J. Nurs. Stud., 404, 367373.
Baraz S., Parvardeh S., Mohammadi E., et al. 2010: 1995
Dietary and fluid compliance, an educational interven- 1985
tion for patients having haemodialysis, J. Adv. Nurs.,
661 , 6068. 2008
Chow S. K., Wong F. K.,2010: Health-related quality of
life in patients undergoing peritoneal dialysis: Effects of 1998
a nurse-led case management programme, J. Adv. Nurs., Wong F. K., Chow S. K., Chan T. M., et al.2009: Evalua-
668 , 17801792. tion of a nurse-led disease management programme for
Cox C. L.1982: An interaction model of client health chronic kidney disease: A randomized controlled trial,
behavior theoretical prescription for nursing, Adv. Nurs. Int. J. Nurs. Stud., 473, 268278.
Sci., 5, 4156. Yamagata K., Makino H., Akizawa T., et al.2010: Design
1996 and methods of a strategic outcome study for chronic
kidney disease: Frontier of renal outcome modifications
36500505 in Japan, Clin. Exp. Nephrol., 142, 144151.
2008CVD

J. Jpn. Acad. Nurs. Sci., Vol. 32, No. 1, 2012 29