K. Vader1,2, K. O'Brien3, S. Chan Carusone4,5, L. Baxter6, F. Ibáñez-Carrasco3, A. Stewart7,3, P. Ahluwalia8, C. Murray4, R. Aubry3, P. Solomon5
1Queen's University, Kingston, Canada, 2Kingston Health Sciences Centre, Kingston, Canada, 3University of Toronto, Toronto, Canada, 4Casey House, Toronto, Canada, 5McMaster University, Hamilton, Canada, 6Community Member, Halifax, Canada, 7St. Michael's Hospital, Toronto, Canada, 8Realize, Toronto, Canada
Background: Adults aging with human immunodeficiency virus (HIV) are living longer with the potential combination of physical, mental, and social health challenges associated with HIV, multimorbidity, and aging, known as disability. In 2017, a new interdisciplinary day health program at Casey House (a speciality HIV hospital in Toronto, Canada) was implemented offering publicly funded physiotherapy to adults aging with HIV and complex health issues. Physiotherapists can play and important role in the care of adults aging with HIV by addressing impairments, activity limitations, and social participation restrictions. Despite the potential role of physiotherapy, to our knowledge, no research to date has explored the perspectives of adults aging with HIV and health care providers related to their experiences with the implementation of physiotherapy in an HIV community-based care setting.
Purpose: The purpose of this research was to understand the strengths, challenges, and perceived impact of implementing physiotherapy into a day health program on health outcomes from the perspective of adults aging with HIV and health care providers working in HIV care.
Methods: We conducted a descriptive qualitative study using face-to-face semi-structured interviews. We recruited adults aging with HIV who had accessed physiotherapy in the day health program at Casey House and health care providers working in HIV care. Interviews were audio-recorded, transcribed verbatim, and reviewed for accuracy by the interviewer. Data were analyzed using conventional content analysis where each transcript was coded by two researchers. Once all transcripts were coded, codes were abstracted into larger themes by the research team. We used reflexivity, multiple data sources, and regular in-person meetings to establish trustworthiness of the data.
Results: We interviewed fifteen adults aging with HIV (n=15) and five health care providers. The majority of participants aging with HIV identified as men (8/15), median age of 57 years (≥ 50 years of age: 14/15; 93%), and reported living with a median of 7 comorbidities in addition to HIV. Strengths to implementing physiotherapy in the day health program included: co-location of the physiotherapist within the health care team; a tailored approach to physiotherapy care within the context of HIV, fulfilling a need for rehabilitation in the HIV community; and improved access to rehabilitation interventions. Challenges to implementing physiotherapy in the day health program included: a perceived mismatch of expectations between the client and physiotherapist, inconsistent client attendance at physiotherapy visits, and managing complex and diverse client needs. The perceived impact on health outcomes of implementing physiotherapy in the day health program included: improved physical performance and function, benefits to psychosocial health, and improved coordination of comprehensive care.
Conclusion(s): Results provide in-depth perspectives on the implementation of physiotherapy into a day health program geared towards adults aging with HIV and complex health issues. Overall, implementing physiotherapy with this day health program was perceived positively by adults aging with HIV and health providers in HIV care.
Implications: This model of care provides a foundation of understanding for integrating physiotherapy in other HIV community-based care settings.
Funding, acknowledgements: Canadian Institutes of Health Research (CIHR) and Connaught Community Partnership Research Program (University of Toronto)
Keywords: HIV, physiotherapy, qualitative research
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? Yes
Institution: University of Toronto
Committee: HIV Research Ethics Boards
Ethics number: 36717
All authors, affiliations and abstracts have been published as submitted.
