Original Research

The effects of a physiotherapist-led exercise intervention on peripheral neuropathy among people living with HIV on antiretroviral therapy in Kigali, Rwanda

David K. Tumusiime, Aimée Stewart, Francois W.D. Venter, Eustasius Musenge
South African Journal of Physiotherapy | Vol 75, No 1 | a1328 | DOI: https://doi.org/10.4102/sajp.v75i1.1328 | © 2019 David K. Tumusiime, Aimée Stewart, Francois W.D. Venter, Eustasius Musenge | This work is licensed under CC Attribution 4.0
Submitted: 07 January 2019 | Published: 12 August 2019

About the author(s)

David K. Tumusiime, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
Aimée Stewart, Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
Francois W.D. Venter, Witwatersrand Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa; and, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
Eustasius Musenge, Division of Biostatistics and Epidemiology, School of Public Health, University of Witwatersrand, Johannesburg, South Africa


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Abstract

Background: HIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches.

Objectives: This study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART).

Methods: A 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson’s chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05).

Results: At 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity – mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome.

Conclusion: A physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms.

Clinical implications: Physiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.


Keywords

peripheral neuropathy; physiotherapy; exercise; HIV; ART; randomised controlled trial; Rwanda

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