PROFILE OF MOBILITY EXPERIENCED BY PEOPLE LIVING WITH HIV RECEIVING PHYSIOTHERAPY IN AN INPATIENT REHABILITATION SETTING

George B.¹, Hawkins C.¹, Rackstraw S.¹

¹Mildmay Hospital, London, United Kingdom

Background: Mildmay Hospital in London provides specialist neuro-cognitive assessment and rehabilitation for people living with HIV (PLHIV) (>17 years) experiencing physical, cognitive and psychological co-morbidities associated with HIV disease.
Over a quarter of PLHIV in the UK are ≥ 50 years with increasing reports of frailty and episodic disability. Amongst this ageing and diverse cohort it is important to deliver physiotherapy interventions that maximise function and promote effective participation in everyday living. In the context of the need to quantify service outcomes the UK Functional Independence Measure and Functional Assessment Measure (FIM FAM) is captured as part of regular clinical practice. It is an 18 item global measure of disability scored through direct observation and assessment by the multidisciplinary team.

Purpose: To analyse admission and discharge FIM FAM scores alongside demographic data to assess the profile of mobility experienced by service users and the impact of physiotherapy intervention.

Methods: A retrospective analysis was conducted of admission and discharge FIM FAM scores of patients admitted for specialist HIV neuro-cognitive rehabilitation between 2013 and 2016. Exclusion criteria included clients readmitted to acute care, death and incomplete data. Motor FIM scores, which include 7 items of mobility and locomotion, were extracted from FIM FAM and evaluated between four subgroups of assistance required: Independent (range 42-49), Minimal (range 29-41), Moderate (range 15-28) and Maximum (range 7-14). Demographic data including ethnicity and primary diagnosis were collected. Comparisons of number, age, and median change in score from admission to discharge were made.

Results: Scores were collected from 91 patients with a mean age of 52 years, mostly male (n=61, 67%) and mixed ethnicity; Black African 44%, Caucasian 40%, Black-Caribbean 11% and Asian 5%. The most common primary diagnoses were those of the central nervous system (n=67, 74%) including HIV Encephalopathy (n=32, 35%), Progressive Multifocal Leukencephalopathy (n=10, 11%) and Cerebral Toxoplasmosis (n=8, 9%). Following this, respiratory illnesses (n=10, 11%) including Pneumocystis jiroveci Pneumonia, COPD and Pulmonary Tuberculosis were commonly reported. 59% of patients (n=54) required staff assistance on admission, with a trend of increasing mean age with greater requirement for assistance: Independent (n= 37, 41%, 51 years), Minimal (n=22, 24%, 48 years), Moderate (n=20, 22%, 54 years), Maximum (n=13, 14%, 56 years). On discharge 67% of patients (n=61) were independent with significant differences found between admission and discharge Motor FIM scores in all groups (p 0.001): Independent 2.0 (range 0-6), Minimal 7.0 (range 0-15), Moderate 15.5 (range 1-31) and Maximal 6.0 (range 0-26).

Conclusion(s): PLHIV are presenting to rehabilitation with a broad range of primary diagnoses leading to mobility restrictions. Although the greatest change in Motor FIM score occurred in those requiring moderate assistance on admission, all groups demonstrated significant change underlying the impact of physiotherapy intervention. This has lead to increasing independence on discharge and with increasing self-management, likely improvements in well-being and quality of life. Further research is needed to determine whether a minimal clinically important difference in mobility was achieved.

Implications: Physiotherapy contributes to improved functional outcomes in PLHIV and is a vital component of assessment and rehabilitation.

Funding acknowledgements: No funds were received.

Topic: Oncology, HIV & palliative care

Ethics approval: Data has been gathered as part of routine clinical practice; as such Ethics Approval was not required.

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