CONSULTATIVE, PROACTIVE PHYSICAL THERAPY FOR PEOPLE WITH LUPUS: A CASE REPORT

PV288 / #731 Case Report Poster Topic: AS09 - Emerging Approaches in SLE Management Late-Breaking Abstract Introduction Physical therapy (PT) can facilitate increased exercise through education, an individualized exercise routine, goal setting, and supportive resources. However, traditional PT focuses on function restoration rather than proactive measures to prevent the advancement of morbidity. We present the application of a proactive physical therapy (PAPT) approach for patients with SLE. Case Presentation With Investigation Four patients with SLE were referred to PT by a Rheumatologist shortly after diagnosis. Patients 1) completed a PT evaluation of their current functional level including gait speed measured by the 10-meter walk test (10mwt), functional exercise capacity measured by the 6-minute walk test (6mwt), functional strength measured by the 5x sit-to-stand (5xSTS), balance measured by the MiniBESTest, 2) received education on aerobic and strengthening exercise guidelines, 3) received goal setting support, and 4) established an exercise routine at an appropriate intensity using shared decision-making. Additional assessments included the fatigue severity scale (FSS), pain detect questionnaire, Godin leisure time questionnaire, and self-reported exercise behavior. Patients were seen at baseline, week 2, week 6, week 10, week 16, and week 24. Aerobic exercise was introduced at baseline, and strength exercise was introduced at week 2. Each week the exercise prescription progressed with the goal of meeting recommended exercise guidelines by week 16. All outcomes were reassessed at week 24. At week 24, 2 patients reported regular aerobic and strengthening participation that met or exceeded exercise guidelines. Both patients demonstrated improvements in gait and functional mobility measured by functional outcome measures. P1 demonstrated a 0.09 m/s increase in her 10mwt SSV, no change in her 10mwt FV, a 33-meter increase in her distance walked in the 6mwt, 3.23 second improvement in the 5xSTS, and remained stable in her balance on the MiniBESTest. P2 demonstrated a 0.28 m/s increase in her 10mwt SSV, 0.58 m/s increase in her 10mwt FV, indicating clinically meaningful change. She also demonstrated a 35 meter increase in her distance walked in the 6mwt, 0.87 second improvement in the 5x STS, and remained stable in her balance on the MiniBESTest. P1 reported improvement on her FSS from 61 to 34, and P2 improved from 51 to 36, indicating significant improvement in fatigue. P1 improved her score on the pain detect from 17/35 to 11/35, and P2 improved from 25/35 to 12/35, indicating clinically meaningful improvements in self-reported pain. P1 reported improved self-reported exercise minutes via the Godin-leisure-time questionnaire from 36 to 37, and P2 improved from 12 to 85, indicating significant improvement in time spent exercising. One patient was unable to schedule her evaluation secondary to personal issues and 1 patient was lost to follow-up after week 10. Literature Review Physical activity is an evidence-based modifiable lifestyle behavior that helps manage symptoms of SLE. Specifically, exercise training may improve cardiovascular capacity and physical function and decrease fatigue in people with systemic lupus erythematosus (SLE) without symptom exacerbation. Unfortunately, 60-72% of people with SLE are not sufficiently physically active (<150 minutes of moderate-to-vigorous physical activity (MVPA)/week per WHO guidelines). Efforts to improve physical activity levels of people with SLE are sorely needed to optimize physical health and functioning. Discussion A PAPT model of care is feasible and effective for patients newly diagnosed with lupus. Patients met established exercise guidelines and maintained or improved physical function. Modifications to the number of visits may be considered to improve follow-through.