PHYSIOTHERAPY AND PAIN MANAGEMENT AMONG ADULTS AGING WITH HIV WITHIN A SPECIALITY HIV DAY HEALTH PROGRAM: A MIXED-METHODS STUDY

S. Chan Carusone^1,2, K. Vader^3,4, R. Aubry⁵, P. Ahluwalia⁶, P. Solomon², C. Murray¹, F. Ibáñez-Carrasco^7,5, L. Baxter⁸, A. Stewart^7,5, K. O'Brien⁵

Background: Pain experienced among adults aging with HIV can be associated with disability, decreased retention in HIV care, and poorer quality-of-life.

Purpose: To describe the nature and extent of pain experienced among adults aging with HIV and its relation to seeking physiotherapy care within a speciality HIV day health program in Toronto, Canada.

Methods: We conducted a descriptive mixed-methods study involving qualitative (semi-structured interviews) and quantitative (chart review) approaches. We interviewed adults aging with HIV who accessed physiotherapy in a speciality HIV day health program to explore reasons for seeking physiotherapy and goals for treatment. We extracted data from participants’ charts including pain (location and type), participant-identified goals of care, the number and focus of physiotherapy sessions, HIV Disability Questionnaire (HDQ) responses, and Brief Pain Inventory (BPI) scores. We analyzed interview transcripts and narrative notes extracted from charts using content analytical techniques.  We conducted a descriptive analysis of quantitative data extracted from charts and self-reported questionnaires using frequencies and percentages, and medians and interquartile ranges (IQR).  

Results: Of the 15 participants (n=15), the majority (14/15, 93%) were ≥ 50 years of age (median age of all participants was 57 years). Eight of the participants identified as male (53%), six as female (40%), and one as fluid (7%). Participants were living with a median of seven concurrent health conditions, 11 (73%) reported chronic joint or muscle pain, and four (27%) reported pain from peripheral neuropathy. The highest HDQ severity scores were in the day-to-day activities’ domain (median: 39/100; IQR: 14,58). The median length of time participants engaged in physiotherapy care was five months (IQR: 2,12), attending a median of four sessions (IQR: 3,14). Reasons for seeking physiotherapy commonly related to mobility (n=8; 53%) or pain relief (n=4; 27%). Participants commonly described engaging in physiotherapy to address pain related to ‘numbness’, ‘back pain’, and ‘cramps’, in their hands, feet, and back, whereby pain affected their daily activities and sleep. During their initial physiotherapy assessment, two (13%) participants identified no pain. Of the 11 participants who completed the BPI, the median usual pain score was 5/10 (10 =‘pain as bad as you can imagine’) (IQR: 4,8), and a median combined pain intensity score of 4.8/10 (IQR: 4.3,7.4). Four (36%) participants met BPI criteria for severe pain and six (54%) for moderate pain. Pain was reported at a median of one location (IRQ:1,2), most commonly in the low back (53%), hip (40%), and knee (33%). Pain reduction was the most commonly reported participant goal (60%), followed by improving strength (47%) and mobility (33%). Pain management was the second most common primary focus of physiotherapy intervention (20%), behind exercise (67%).

Conclusion(s): Chronic joint or muscle pain was frequently reported by adults aging with HIV who were accessing physiotherapy. Physiotherapy in this setting commonly focused on pain management, with approximately a quarter of participants seeking physiotherapy to manage pain.

Implications: Results highlight the role of physiotherapy in pain management for adults aging with HIV within a speciality HIV day health program.

Funding, acknowledgements: Canadian Institutes of Health Research (CIHR) and Connaught Community Partnership Research Program (University of Toronto)

Keywords: HIV, physiotherapy, pain

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? Yes

Institution: University of Toronto

Committee: HIV Research Ethics Board

Ethics number: 36717