Preliminary outcomes of a pilot physical therapy program for HIV-infected patients with chronic pain

Abstract

Chronic pain in HIV-infected individuals is common and often undertreated. Physical therapy (PT) is an evidence-based nonpharmacologic treatment for chronic pain. Our objective is to present the results of a pilot PT program in an HIV pain/palliative care clinic, which is embedded within a Ryan White-funded multidisciplinary HIV primary care clinic. Medical records of HIV-infected patients participating in a PT program between November 2012 and July 2013 were retrospectively reviewed. Pain scores on a 0–10 scale and cost data were collected and analyzed. Among 43 patients referred, 27 collectively attended 86 sessions. Median age of enrolled patients was 54 (IQR 49–58). Sixteen (59%) were African-American and 20 (77%) had an undetectable HIV viral load. Mean pain score at initial visit was 6.5 (SD = 1.1). The average session-level decrease was 2.6 (SD = 1.7) and patient-level decrease was 2.5 (SD = 1.2). The largest payors were Medicare managed care (28%), Medicaid (21%), and Ryan White grant-related funds (18%). When the first four months of the program are excluded to account for slow start-up, the program's monthly net revenue during the remaining five months was $163. We present preliminary data from a low-cost pilot PT program integrated into an HIV clinic in a primary care setting associated with clinically significant improvements in pain. Further investigation into the implementation of such programs is essential.

Keywords:

• HIV
• chronic pain
• physical therapy
• nonpharmacologic treatment
• Ryan White program

Acknowledgments

We would like to acknowledge the UAB Innovation Board grant program, which covered initial program costs. We would also like to thank Elizabeth Bohorfoush, DPT for providing the program's clinical services.

Funding

This research was supported by the UAB Center for AIDS Research CFAR, an National Institutes of Health (NIH)-funded program [grant number P30 A1027767] that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. JSM is supported by AHRQ [grant number 1K12HS02169401]. AOW has received consulting fees from Definicare, LLC. CSR is supported by NIA [grant number 7K07AG031779].

Additional information

Funding

Funding: This research was supported by the UAB Center for AIDS Research CFAR, an National Institutes of Health (NIH)-funded program [grant number P30 A1027767] that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. JSM is supported by AHRQ [grant number 1K12HS02169401]. AOW has received consulting fees from Definicare, LLC. CSR is supported by NIA [grant number 7K07AG031779].