What does a Physiotherapist see when attending a HIV and sexual health conference? The answer is; novel science relevant to Physiotherapy practice and produced by Physiotherapists; holistic multidisciplinary approaches that embraces rehabilitation across the continuum of care for people living with HIV; and a strong community of people living with HIV who welcome Physiotherapists to improve research, policy and practice.
This blog is about attendance to the 4th joint conference of the British HIV Association (@BritishHIVAssoc) and British Association for Sexual Health and HIV (@BASHH_UK) in Edinburgh, Scotland, 17-20th April 2018 (#BHIVABASHH18). Physiotherapy and more broadly rehabilitation was present at this conference, so this Blog will explore some of the key features seen through the eyes of Physiotherapist when attending a conference on HIV and sexual health. Maybe next year there will be more Physiotherapists who will get their own experiences. All oral and poster presentations are available online.
Firstly there is the conference content produced by Physiotherapists. Blake George, Physiotherapist from Mildmay (@PhysioBlake) who presented his poster on the profile of mobility experienced by people living with HIV receiving Physiotherapy within an inpatient rehabilitation setting, demonstrating the range of impairments experienced and the positive impact of Physiotherapy on mobility and functional outcomes. Rebecca Mullin, Physiotherapist from Guys and St Thomas’ NHS Foundation Trust (@BeccaMullin) presented her poster on a joint Physiotherapy and Dietician metabolic clinic for people living with HIV, highlighting the multi-morbidity experienced at younger ages, and with specialist self-management support from allied health professionals, improvements are observed in cardiovascular risk and body mass index outcomes. I also presented (@darrenabrown) on the HIV Physiotherapist service from Chelsea and Westminster Hospital NHS Foundation Trust (@ChelWestTherapy) a poster on the introduction of the 5 times it to stand test into a group rehabilitation intervention (Kobler Rehabilitation Class), indicating improvements in function observed when attending some sessions and the value of open access services accommodating episodes of disability. My second poster was on the self-reported functioning and disability of people living with HIV and/or Cancer during acute hospital inpatient care using the WHODAS 2.0, whereby mobility outcomes were the worst scored challenges, with disability severity scores correlating with length of stay and the need of Physiotherapy interventions.
Rehabilitation professionals also had a role in the development of the new BHIVA Standards of Care for People living with HIV 2018 released at the conference. Rehabilitation in HIV Association (@RehabHIV) chair and Occupational Therapist Esther McDonnell (@esthermmc) was part of the writing committee and Prof Richard Harding (@RHardingCSI), professor of palliative care and rehabilitation led the palliative care standard, which highlights the importance of palliative rehabilitation. BHIVA also tweeted my comments on the standards of care from the perspective of a Physiotherapist. The standards have rehabilitation noted throughout with reference to accessing Physiotherapy across the continuum of care including inpatient and outpatient settings. The new focus of the updated standards is person-centred care, across the life-course, placing people living with HIV at the centre of their own care. Therefore people living with HIV were engaged throughout developing the standards, making the voice of patients visible.
Dr Katherine Bristow (@KCL_CSI) presented initial development data on a novel HIV Patient Reported Outcome Measure or PROMS, which includes 6 domains (physical, cognitive, psychological welfare, social and information needs), plus well-being thermometer and free text. This PROM will include a question on functional capacity in daily living, and the PROM will provide benefits for people living with HIV and for HIV services.
Dr Chris Ward (@chrisw0440) led interesting discussions about behaviour research of gym use, non-steroidal supplements and drug interactions, bulking supplements and interactions with HIV medications, alongside the side effects of exercise with over the counter medications and the reasons some gay men might exercise, while highlighting the benefits of exercise among people living with HIV. Important social constructs may impact on reasons to exercise, consequently all health professionals and especially Physiotherapists prescribing exercise for health and well-being related purposes, need to be aware and sensitive to these issues relating to sex, drugs, medications, body image and sexuality.
The Public Health England “Positive Voices” presentation by Meaghan Kall (@kallmemeg) highlighted the high unmet need and gaps in provision of social and welfare services, particularly dealing with loneliness and isolation. Additionally an exciting panel represented marginalised populations, including women, transgender patients, injecting drug users and people from different ethnic backgrounds. Prof Jane Anderson (@ProfJAnderson) highlighted the importance of women centred care and the new publication #InvisibleNoLonger by the Sophia Forum (@SophiaForum). Dr Kate Nambiar (@KateNambiar) discussed the importance of improving trans inclusivity in designing services and research, including the use of the 2 stage gender questions. There was also fantastic trans health resources highlighted from CliniQ (@Clini_Q). Dr Rageshri Dhairyawan (@crageshri) discussed intersectionality theory and the impact of faith, community and sexuality as factors affecting engagement in care, while referencing the “social GRRAACCEESS” model of what makes up a person’s identity. While Dr Emma Thompson (@emcat1) reminds us that people who inject drugs may have faced childhood and adult adversities and that “people don’t inject drugs because everything in your life is ok, we would do well to recognise this to address the stigma people experience”.
Ageing and frailty were common themes among poster presentations. Posters included data on; presence of complex comorbidities, social care needs and complex HIV management issues among people ageing with HIV; high burden of multimorbidity and frailty at earlier ages in a combined HIV and elderly medicine clinic; low levels of physical activity resulted in increased risk of frailty, while exercise could help reverse frailty in older adults with HIV; the link between inflammation and frailty in older adults with HIV; the experiences of women ageing with HIV; modelling the link between cognition, apolipoprotein and frailty in mid-aged people living with HIV. Other interesting posters included the high burden of pain experienced by people living with HIV, measuring quality of life among people living with HIV using EQ5D5L, systematic review of mHealth interventions to support self-management in HIV, impact of rheumatic symptoms on physical function and quality of life, breathlessness wheeze and cough more common in people living with HIV, and the use of the Patient Activation Measure demonstrates low activation in the presence of comorbid physical and mental health problems.
Cardiovascular disease was another popular topic with presentations highlighting among people living and ageing with virologically suppressed HIV, some cardiovascular risk factors are associated with cognitive performance, such as anti-hypertensives, being overweight and low haemoglobin. Early onset menopause is associated with cardiovascular disease among women living with HIV. People living with HIV also have higher prevalence of non-calcified plaques among a younger population with diabetes and hyperlipidemia. Additionally 25% of people living with HIV aged over 50 years were current smokers, compared to 15% of age-matched controls, and the importance of traditional modifiable risk factors.
There were so many more topics of relevance to Physiotherapists inlcuding bone health, pain, mHealth, self-management and much much more. Physiotheraists were also highlighted by Dr Laura Waters (@drlaurajwaters) for their role in non-pharmacological management of pain management within HIV care, in the face of the increasing opioid crisis.
There were also lots of opportunities to promote physical activity, by having a 5sx sit-stand competition among delegates to raise awareness of functional performance measures in clinical practice and promoting physical activity among delegates, encouraging the use of the stairs instead of the escalators.
Lastly, #BHIVABASHH18 was just great fun. There was loads to learn and share, but you cant beat a conference where the conference organising committee member stage dives at the Gala dinner. Dr Laura Waters, we love you!
Physiotherapists, come join us at the next British HIV Association conference, and see how much you can learn, contribute (and maybe dance).