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Van Aswegen H1,2, Roos R1,2, McCree M2, Quinn S1, Mer M2,3
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2University of the Witwatersrand, Wits-University of Queensland Critical Care Infection Collaboration Group, Johannesburg, South Africa, 3University of the Witwatersrand, Divisions of Critical Care and Pulmonology, Johannesburg, South Africa
Background: Tuberculosis (TB) remains a significant global healthcare problem but there is limited information available on its impact on people's health status and quality of life (QOL). Understanding physical and functional impairments that people with active TB present with is important in developing rehabilitation programmes while they receive anti-TB therapy to optimise their recovery.
Purpose: The purpose of this pilot study was to describe demographics, physical and functional status and QOL for those diagnosed with active TB and to evaluate changes in their outcomes over the six months of anti-TB therapy.
Methods: A prospective, observational, longitudinal pilot study was performed. Patients with acute pulmonary TB admitted to a quaternary level hospital were recruited. Physical function (muscle architecture and power, balance, and exercise capacity), respiratory symptoms (breathlessness) and QOL were assessed after initiation of anti-TB therapy in hospital, and at six weeks and six months post discharge as participants completed their anti-TB therapy. Descriptive statistics were used to present the data and inferential tests were used to evaluate changes over time.
Results: The study consisted of n=12 participants (mean age 31.5 (9.1) years; n=10 (83.3%) female) and majority were HIV positive (n=9, 75%). Participants reported 'very slight' to 'slight' breathlessness at all three assessments. Non-significant changes in muscle cross-sectional area (CSA), thickness and echo intensity were observed over the six months period (p=0.2, p=0.19 and p=0.18 respectively). Small improvements in muscle power were observed over six months. Balance impairment was highlighted when vision was removed during testing. Clinically important improvements in 6MWT distance were observed between hospitalisation and six weeks assessment (mean change 103.7m). The EQ-5D VAS mean score during hospitalisation (n=12) was 66.3 (30.2; 95%CI: 41-91.5; range: 20-100), at six weeks (n=9) it was 68.1 (31.6; 95%CI: 41.7-94.6; range: 20-100) and at six months (n=8) the mean score was 68.8 (31.9; 95%CI: 42-95.5; range: 20-100). The changes in mean EQ-5D VAS scores observed over the six months period were not significant (p=0.44). At six months participants reported mild symptoms of pain and discomfort.
Conclusion(s): Participants' physical and functional recovery during anti-TB therapy seems to be limited by neuromusculoskeletal factors which highlights the need for ongoing physical rehabilitation during pharmacological management of the disease.
Implications: This pilot study provides a profile of the physical and functional impairments experienced by people diagnosed with and recovering from active TB infection (with or without HIV co-infection) in a developing country as well as their return to work rate and QOL. This is the first study to report on changes in muscle architecture, mass and power as well as balance dysfunction in the TB population. These findings will enable rehabilitation specialists to identify the needs of this population and to develop appropriate rehabilitation interventions to address these needs so that their QOL may improve.
Keywords: Tuberculosis, Physical and functional impairments, HIV
Funding acknowledgements: This study was supported by funds made available from the Wits-University of Queensland Critical Care Infection Collaboration Group.
Purpose: The purpose of this pilot study was to describe demographics, physical and functional status and QOL for those diagnosed with active TB and to evaluate changes in their outcomes over the six months of anti-TB therapy.
Methods: A prospective, observational, longitudinal pilot study was performed. Patients with acute pulmonary TB admitted to a quaternary level hospital were recruited. Physical function (muscle architecture and power, balance, and exercise capacity), respiratory symptoms (breathlessness) and QOL were assessed after initiation of anti-TB therapy in hospital, and at six weeks and six months post discharge as participants completed their anti-TB therapy. Descriptive statistics were used to present the data and inferential tests were used to evaluate changes over time.
Results: The study consisted of n=12 participants (mean age 31.5 (9.1) years; n=10 (83.3%) female) and majority were HIV positive (n=9, 75%). Participants reported 'very slight' to 'slight' breathlessness at all three assessments. Non-significant changes in muscle cross-sectional area (CSA), thickness and echo intensity were observed over the six months period (p=0.2, p=0.19 and p=0.18 respectively). Small improvements in muscle power were observed over six months. Balance impairment was highlighted when vision was removed during testing. Clinically important improvements in 6MWT distance were observed between hospitalisation and six weeks assessment (mean change 103.7m). The EQ-5D VAS mean score during hospitalisation (n=12) was 66.3 (30.2; 95%CI: 41-91.5; range: 20-100), at six weeks (n=9) it was 68.1 (31.6; 95%CI: 41.7-94.6; range: 20-100) and at six months (n=8) the mean score was 68.8 (31.9; 95%CI: 42-95.5; range: 20-100). The changes in mean EQ-5D VAS scores observed over the six months period were not significant (p=0.44). At six months participants reported mild symptoms of pain and discomfort.
Conclusion(s): Participants' physical and functional recovery during anti-TB therapy seems to be limited by neuromusculoskeletal factors which highlights the need for ongoing physical rehabilitation during pharmacological management of the disease.
Implications: This pilot study provides a profile of the physical and functional impairments experienced by people diagnosed with and recovering from active TB infection (with or without HIV co-infection) in a developing country as well as their return to work rate and QOL. This is the first study to report on changes in muscle architecture, mass and power as well as balance dysfunction in the TB population. These findings will enable rehabilitation specialists to identify the needs of this population and to develop appropriate rehabilitation interventions to address these needs so that their QOL may improve.
Keywords: Tuberculosis, Physical and functional impairments, HIV
Funding acknowledgements: This study was supported by funds made available from the Wits-University of Queensland Critical Care Infection Collaboration Group.
Topic: Oncology, HIV & palliative care
Ethics approval required: Yes
Institution: University of the Witwatersrand
Ethics committee: Human Research Ethics (Medical) committee
Ethics number: Wits HREC (M150857)
All authors, affiliations and abstracts have been published as submitted.
