Hemodialysis,Transportation,and Mobility: A Systematic Review From an Occupational Therapy Perspective

Abstract

Adults on maintenance hemodialysis face transportation barriers that disrupt treatment adherence, roles, routines, and quality of life. To review evidence of transportation barriers in adults on hemodialysis and their impact on adherence, quality of life, and community participation. A systematic review was conducted, searching MEDLINE, CINAHL, Cochrane Library, and ScienceDirect (2015–2025) databases for English-language studies. Eleven studies (n = 28–115,982) from eight countries met inclusion criteria. Four interrelated themes emerged from the synthesis: travel distance and time, transportation costs, mode of transport, and service reliability and availability. These barriers collectively constrained treatment adherence, autonomy, and participation in daily occupations, ultimately diminishing autonomy and quality of life. Transportation is a key environmental constraint on occupational performance in hemodialysis. Occupational therapists should assess transport needs, promote mobility supports, and develop interventions to enhance adherence.

Plain Language Summary

How Transportation Problems Affect People on Hemodialysis: What This Means for Daily Life and Occupational Therapy

People who receive hemodialysis must travel to a dialysis center three to four times each week. This travel can be stressful, tiring, expensive, and time-consuming. Our study reviewed research from several countries to understand how transportation difficulties affect the daily lives, health, and well-being of adults on hemodialysis, and why these challenges matter for occupational therapy. We found that many people have to travel long distances, often more than 30 min each way. Long travel times reduce their available energy for everyday activities such as household tasks, work, socializing, and self-care. Transportation can also be costly, with expenses like parking fees, fuel, or public transport fares causing financial strain. Some people rely on family members or public services to get to treatment, which can limit independence and lead to missed or delayed dialysis appointments when transportation is unreliable. These difficulties are not only inconvenient; they can seriously affect health. Several large studies showed that people who live farther from dialysis centers or who depend on public or medical transport services are more likely to miss treatments and even have higher risk of hospitalizations and death. From an occupational therapy perspective, transportation is a key part of community mobility and daily living. Transportation problems can disrupt routines, reduce participation in meaningful activities, and increase stress. Occupational therapists can help by assessing mobility needs, supporting clients in using community transportation or adaptive driving, working with caregivers, and advocating for better transportation services and policies. Our review shows that transportation is a major factor in the lives of people receiving hemodialysis. Improving transportation options can help people maintain their health, independence, and quality of life.