Evaluation of a physiotherapy-led group rehabilitation intervention for adults living with HIV: referrals, adherence and outcomes.
HIV is characterised by episodes of disability. We report a novel, hospital outpatient rehabilitation intervention, combining physiotherapy-led group exercise and education for people living with HIV (PLWH). This observational study evaluated routine delivery of the 10-week intervention in terms of referral patterns, rehabilitation goals, intervention adherence and change in patient outcomes. Measurements at baseline & 10 weeks included locomotor performance (6 minute walk test; 6MWT), flexibility, upper and lower limb strength and health related quality of life (HRQOL). Adherence was defined as attending ≥8/20 sessions, with reasons for non-adherence identified in retrospective telephone interviews. Goal Attainment Scale measured progression to individual goals. Total 92 referrals were mostly for musculoskeletal (25.0%), oncological (19.6%) or cardio-metabolic (18.5%) reasons, and mostly male (81.5%), Caucasian (70.7%) and older (mean 51.5 years). Common themed rehabilitation goals included improving body image, participation, mobility, health/fitness and function. Adherence was achieved by 42 (46%) patients, with open access utilised by 34 patients, returning (n = 19) or restarting when non-adherent (n = 15). Post-intervention measurements collected for 37 (40%) patients demonstrated improvements in 6MWT distance (p < .001), flexibility (p < .001), strength in triceps (p < .001), biceps (p < .001), Lattisimus Dorsi (p < .001), shoulder-press (p < .001), chest-press (p < 0.001), and leg-press (p < 0.001). HRQOL improved in total score (p < .001), physical (p < .001), emotional (p < .001) and functional (p = .065) subscales. Extent of goal achievement demonstrated 83% of goals was "expected" (n = 57), "somewhat more" (n = 31) or "much more" (n = 14). Reasons for non-adherence from 21 telephone interviews identified physical health challenges, individual factors and time or location issues. This novel rehabilitation approach for PLWH improved function, HRQOL and goal attainment among those completing the intervention. Sub-optimal adherence likely relates to episodic disability.
a Therapies Department , Chelsea and Westminster Hospital , London , UK.
Darren
D
Brown
b School of Health & Social Care, London South Bank University , London , UK.
Austin
A
Claffey
c Department of Palliative Care, Policy & Rehabilitation , King's College London, Cicely Saunders Institute , London , UK.
Richard
R
Harding
D000328:Adult; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D010347:Patient Care Planning; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D012017:Referral and Consultation; D016896:Treatment Outcome; D000070857:Walk Test
HIV; adherence; exercise; physiotherapy; rehabilitation; self-management