Improved Function, Strength, Quality of Life and Goal

Attainment in People Living with HIV

Attending a Physiotherapy-led Group Rehabilitation

Intervention in the UK

D.Brown, A.Claffey, R.Harding

@darrenabrown @ChelWestFT

#RehabHIV- 1st International Workshop on Healthy Living for People Living with HIV, Barcelona, 2-3rd September 2016Abstract 06

2

CONTENT

1 Background to HIV and Rehabilitation

2 HIV Physiotherapy Service

3 2 Year Service Evaluation of Kobler

Rehabilitation Class

4 Future Opportunities

#RehabHIV

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Living Longer

People living with HIV

are living longer

Health Conditions

Susceptible to developing health

conditions arising from HIV, long-

term ARVs and Ageing

Multi-morbidity

As a result, multi-morbidity,

is becoming increasingly

common among people

living with HIV

Health Challenges

The combination of HIV, ageing and

associated multi-morbidity can create

physical, cognitive, mental and social

health-related challenges

Disability

Collectively these health-related

challenges may be conceptualised as

disability, & rehab is recommended to

support physical, mental & social

health challenges

Episodic Disability

The episodic disability

framework describes the unique

dimensions of disability

experienced by people living

with HIV

50+

WHATS REHABILITATION GOT TO DO WITH IT?

#RehabHIV

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EPISODIC DISABILITY FRAMEWORK

#RehabHIV @KellyOBrien25

Dimensions of Disability

Symptoms /

ImpairmentsChallenges to Social

InclusionUncertainty

Parental

Roles

Work

&

School

Personal

RelationshipsOther

Social

Roles and

Activities

Difficulties with

Day-to-Day

Activities

Adverse

Effects

Of HIV or

Meds

(Fatigue,

Diarrhea,

Nausea,

Pain, etc.)

Fear,

Decreased

Self Esteem,

Shame or

Embarrassment,

Loneliness

Stress,

Anxiety, and

Depression

O'Brien et al. Health and Quality of Life Outcomes2008 6:76 doi:10.1186/1477-7525-6-76http://www.hqlo.com/content/6/1/76

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REHABILITATION INTERVENTIONS IN HIV#RehabHIV

http://bmjopen.bmj.com/content/4/5/e004692.full

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HIV & EXERCISE

#RehabHIV

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001796/frame.html

Exercise leads to improvements in;

- Cardiopulmonary fitness (VO2max, exercise time)

- Body composition (lean body mass, leg muscle area,

% body fat)

- Strength (chest press, knee flexion)

- Depression symptoms

- Quality of life (SF-36 questionnaire)

- No change in CD4 count or Viral Load

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REHABILITATION PRACTISE

ONE:ONE INTERVENTION

SPECILIALIST HIV PHYSIO CLINIC

GROUP INTERVENTIONKOBLER REHABILITATION CLASS

Outpatient Specialist

HIV Physiotherapy

Service

#RehabHIV

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KOBLER REHAB CLASS

#RehabHIV

OUTCOME MEASURES

HEIGHT

WEIGHT

BODY SHAPE

HEART RATE

6MWT

STRENGTH

FAHI

FLEXIBILITY

GOALS

WEEK 0WEEK 10

DROP-IN>10 WEEKS

9

KOBLER REHAB CLASS

#RehabHIV

Referrals 75%

MALE

GENDERWHITE

ETHNICITY

70%

32MIN

75MAX

AVERAGE

AGE

52

35%

DUAL

ONCOLOGY

DIAGNOSIS

Referrals (n=92)

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KOBLER REHAB CLASS

#RehabHIV

Referrals M

US

CU

LO

SK

EL

ET

AL

ON

CO

LO

GIC

AL

CA

RD

IOM

ET

AB

OL

IC

DE

CO

ND

ITIO

NIN

G

PS

YC

HO

LO

CIA

L

RE

SP

NE

UR

O

PA

IN FA

TIG

UE

11

KOBLER REHAB CLASS

#RehabHIV

Goals

12

46%

KOBLER REHABILITATION CLASS

ADHERENCE

37%

KOBLER REHABILITATION CLASS

RETURNED / RESTARTED

WHEN NON-ADHERENT

KOBLER REHAB CLASS

#RehabHIV

Adherence

13

KOBLER REHAB CLASS

#RehabHIV

Locomotor

PerformanceStrength

Health Related

Quality of LifeFlexibility Goal Attainment

Exceeding clinically important difference

in COPD, heart failure, stroke survivors and community dwelling

older adults

86m (p<0.001)

TRICEPS (P<0.001)

BICEPS (P<0.001)

LATTISIMUS DORSI(P<0001)

SHOULDER PRES (P<0.001)

CHEST PRESS (P<0.001)

LEG PRESS (P<0.001)

PHYSICAL WELL BEING (P<0.001)

EMOTIONAL WELL BEING (P<0.001)

FUNCTIONAL/GLOBAL WELL BEING (P=0.065)

SOCIAL WELL BEING COGNITIVE FUNCTIONING

8cm (p<0.001) 64% Achieved all

goalsAverage = 3 goals

Outcomes (n=37)

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KOBLER REHAB CLASS

#RehabHIV

Non-Adherence

Telephone Interviews

21

Physical Health

ChallengesEmotional or

Mental Health

Challenges

Travel or LocationIndividual factors

eg: exercising

Independently

Class features

eg: time or

location

x2

week

≥820adherence

62% Willing to attend

48% Able to attend

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FUTURE OPPORTUNITIES

#RehabHIV

The Need of the KRCMark Spreckley LSHTM

Multi-stakeholder needs

analysis of Kobler Rehab Class

NIHR Feasibility TrialRichard Harding &

Matt Maddocks (KCL) and

expanding team

Structurally modifity service

Service Expansion

Providing equity in service

provision across all sites re:

referrals and access

Measurements5x Sit-Stand 1 year trial

Modify as part of NIHR

HIV Disability QuestionnaireCurrently too long, however

being used in research in the

UK to measure presence,

severity & episodic nature

TechnologyUse of technology in

measurements and for use

of biofeedback

Service Improvement Uniform measurement tools

across clinic and class

Incorporating technology in

measurements

CONCLUSION

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#RehabHIV

1Rehabilitation is recommended for people living

with HIV who experience disability and exercise is

safe and effective intervention

2The Kobler Rehabilitation Class is a unique

rehabilitation service designed to meet the needs

of people living with HIV and disability

3Patients who attend and complete measurements

improve function, strength, flexibility, quality of life

and achieve personal goals

4Further development of the service will address the

unique needs of people living with HIV to imporve

accessibility and outcomes

THANK YOU

Darren Brown – Physiotherapist

Chelsea and Westminster Hospital NHS Foundation Trust

London, United Kingdom

@darrenabrown @ChelWestFT

#RehabHIV

#RehabHIV- 1st International Workshop on Healthy Living for People Living with HIV, Barcelona, 2-3rd September 2016Abstract 04