INTRODUCING “FIVE TIMES SIT TO STAND” TEST INTO A GROUP REHABILITATION INTERVENTION FOR ADULTS LIVING WITH HIV IN THE UK

Brown D.¹, Neate K.¹, Mugambwa J.¹, Novis A.², Harding R.³, Nelson M.^4,5, Bower M.^5,6

¹Chelsea and Westminster Hospital NHS Foundation Trust, Physiotherapy, London, United Kingdom, ²King's College London, Department of Physiotherapy, London, United Kingdom, ³King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitaiton, London, United Kingdom, ⁴Chelsea and Westminster Hospital NHS Foundation Trust, HIV Medicine, London, United Kingdom, ⁵Imperial College London, School of Medicine, London, United Kingdom, ⁶Chelsea and Westminster Hospital NHS Foundation Trust, National Centre for HIV Oncology, London, United Kingdom

Background: A physiotherapy-led group rehabilitation intervention for adults living with HIV; Kobler Rehabilitation Class, combines twice weekly exercise and education to improve locomotor performance, physical function and quality of life among those completing post-intervention measurements. Existing measurements completed at week-0 and 10, present time and space burden, with low numbers completing post-intervention measurements. Identification of appropriate measures is required for service improvement; to minimise burden and optimise data collection when allowing attendance dependent on episodes of disability. Measuring chair-rise performance is supported as a functional measure among people living with HIV. “Five times sit to stand” (FTSTS) test is a functional performance measure of lower extremity strength and balance indicating falls risk, measures disability and recommended for standard HIV care.

Purpose: We trialled the FTSTS test to determine feasibility and effectiveness measuring change of functional performance. Secondary objectives aimed to identify longitudinal attendance with open-access beyond 10-weeks.

Methods: From October 2015, we performed a 12-month trial of FTSTS at every attendance, during routine delivery of Kobler Rehabilitation Class. We determined test compliance, baseline performance and change over time near week-10 (between 18-24 sessions), for “adherent”; attending ≥8/20 sessions, and “non-adherent”. We determined proportion of longitudinal attendance beyond 10-weeks.

Results: 66 patients attended over 12-months; male (73%, n=48), mean age 55 years (range 40-78), mean CD4 689, undetectable viral load 92% (n=59/64). FTSTS was completed during 99% (875/888) of attendances. Median FTSTS baseline score 13.3s (range 6.6-64), with 47% (n=31) not requiring upper limb support to complete. Median 5 (range 1-20) attended sessions within 10-weeks, with 28 patients attending near week-10. Adherence achieved by 33% (n=22), attending median 12 sessions (range 8-20), scored baseline FTSTS 12.5s (range 6.9-34) with change over time median 7.0s (range 5.0-14.2) (p=0.0018) and median improvement 5.3s (range 1.8-28.5). “Non-adherent” attending near week-10 (n=10) attended median 4 sessions (range 2-7), scored baseline FTSTS 16.15s (range 9.4-28.3), change over time median 10.35s (range 6.1-18.0) (p=0.003) and median improvement 6.5s (range 0.3-18.3). No significance difference between baseline FTSTS and median improvement between “adherent” and “non-adherent” attending near week-10. Significant improvement was observed in those progressing to no upper limb support to complete FTSTS post-intervention (p=0.0016). Open-access beyond 10-weeks utilised by 39% (17/44) “non-adherent” and 77% (17/22) “adherent. “Adherent “ attended median 19 sessions (range 1-57) and “non-adherent” attended 2 sessions (range 1-30) beyond 10-weeks (p=0.001).

Conclusion(s): The FTSTS showed excellent compliance indicating low burden. Baseline FTSTS scores demonstrate worse performance compared to community dwelling older adults and Parkinson’s disease. Sub-optimal adherence was observed, with “adherent” and “non-adherent” achieving significant change over time FTSTS when attending near week-10. Improvement in FTSTS score “adherent” and “non-adherent” exceeded minimal clinically important difference for COPD, vestibular disorders and older adults. With open-access “adherent” attended significantly more sessions than “non-adherent” beyond week-10.

Implications: The FTSTS is a suitable functional performance measure that could support service improvement and future longitudinal analysis. All patients achieved improvements in chair rise time, indicating the value in attending some sessions and open-access allowing attendance depending of episodes of disability.

Funding acknowledgements: No funding was required for this evaluation

Topic: Oncology, HIV & palliative care

Ethics approval: Ethics was not required to evaluate delivery of routine care

All authors, affiliations and abstracts have been published as submitted.