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

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.