Background: The study objectives were to measure disability prevalence and severity, and examine disability risk factors, among adults living with HIV in London, United Kingdom (UK). Methods: Self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), Equality Act disability definition (EADD), and demographic questionnaire. We calculated proportion (95% Confidence Interval; CI) of “severe” and “moderate” disability measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic questionnaire responses to assess risk factors of “severe” and “moderate” disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis. Results: Of 201 participants, 176 (87.6%) identified as men, median age 47 years, and 194 (96.5%) virologically suppressed. Severe disability prevalence was 39.5% (n = 79/201), 95% CI [32.5%, 46.4%]. Moderate disability prevalence was 70.5% (n = 141/200), 95% CI [64.2%, 76.8%]. Uncertainty was the most severe HDQ disability domain. Late HIV diagnosis was a risk factor for severe disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. Social determinants of health, economic inactivity [OR 2.79; CI 1.08, 7.21] and receiving benefits [OR 2.87; CI 1.05, 7.83], were risk factors for “severe” disability. Economic inactivity [OR 3.14; CI 1.00, 9.98] was a risk factor for “moderate” disability. Economic inactivity, receiving benefits, and having no fixed abode were risk factors (P≤0.05) for higher HDQ severity scores in physical, mental and emotional, difficulty with day-to-day activities, and challenges to social participation domains. Personal factors, identifying as a woman and being aged <50 years, were risk factors (P≤0.05) for higher HDQ severity scores in mental and emotional, uncertainty, and challenges with social participation domains. Conclusions: People living with well-controlled HIV in London UK experienced multi-dimensional and episodic disability. Results help to better understand the prevalence, severity, and risk factors of disability experienced by adults living with HIV, identify areas to target interventions, and optimise health and functioning.

Background and Purpose: Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce.Methods: This study employed a test–retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21–128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1–3) conducted within 24 h and following international standards. Intra‐rater agreement between testing sessions was analyzed using the Bland–Altman method. Test–retest reliability was analyzed using intra‐class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho.Results: Mean difference and 95% limits of agreement for MIP were −0.40 (−23.02, 22.22) cmH₂O between S1 and S2, and 2.14 (−12.79, 16.99) cmH₂O between S2 and S3; for MEP, −4.56 (−29.01, 19.90) cmH₂O between S1 and S2, and 0.29 (−24.28, 24.87) cmH₂O between S2 and S3; and for SNIP, −10.56 (−38.48, 17.37) cmH₂O between S1 and S2, and −6.06 (−27.32, 15.20) cmH₂O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment.Discussion: MIP, MEP, and SNIP in acute and subacute stroke patients show good test–retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.

Physiotherapy is an essential component of respiratory management and mobilisation/rehabilitation for patients in the Intensive Care Unit (ICU). However, the current practices across Europe related to organisational models, referral pathways, or clinical techniques are not well-defined. To examine physiotherapy provision and practice of respiratory management and mobilisation/rehabilitation for mechanically ventilated patients in European ICUs. An online survey was developed, piloted and distributed in 11 languages via national coordinators, professional societies, and social media. The ICU physiotherapy leads, or in their absence, medical/nursing leaders from each ICU (one reply per ICU), completed the survey, which included information regarding ICU structure, physiotherapy provision, and current practice. Data were analysed descriptively. In total, 845 responses from 33 countries were included, with the largest representation from Spain (12%), the United Kingdom (11%), and France (11%). Most respondents were physiotherapists (88%) working in university hospitals (69%) and caring primarily for adult ICU patients (87%). Less than half (41%) of physiotherapists were dedicated to ICU, but 91% of them had received some ICU-specific training. Physiotherapy is initiated upon a referral in 52% of ICUs. It usually includes routine respiratory assessment (80%) and both respiratory management and mobilisation/rehabilitation for mechanically ventilated patients (85%). The most common techniques included endotracheal suctioning (55%) and manually assisted cough (51%), with less frequent use of mechanical insufflation-exsufflation (20%) and saline instillation (18%). Mobilisation/rehabilitation was widely practised, with 76% of respondents reporting patients sitting at the edge of the bed, 69% standing, and 71% walking during their ICU stay. Physiotherapy is a well-integrated part in European ICUs with physiotherapists providing both respiratory management and mobilisation/rehabilitation techniques, although heterogeneity persists in organisation, referral pathways and the use of specific techniques. These results inform the development of future training and workforce planning, ultimately improving interprofessional ICU care across Europe, particularly in underrepresented areas.

Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventilating patient. Data on the current use of NP and OP suctioning by physiotherapists are scarce. To investigate the use of NP and OP suctioning by physiotherapists in the UK. An anonymous online questionnaire was developed in Microsoft Forms. UK-registered physiotherapists working in respiratory practice were invited to complete the survey via professional organisations and social media between May and June 2021. Data were analysed descriptively. Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical speciality levels. The median (IQR) frequency of treatment involving either NP or OP suctioning was 3 (1,5) in the preceding month. Suctioning was usually reported as being successful (92%) and most commonly administered following manual airway clearance techniques (78%), mechanical in/exsufflation (61%), and/or positioning and postural drainage (52%). The majority of respondents reported they performed suctioning with a lubricant (98%) and a nasal pharyngeal airway in situ (95%). Respondents reported experience of a number of adverse effects in relation to NP or OP suction, most notably bleeding (80%), hypoxaemia (63%), and tachycardia (58%). Although NP/OP suctioning is an important ACT in UK physiotherapy practice, it is highly invasive and carries the risk of adverse effects and negative patient experience. Further research and development of adaptations and less invasive alternatives to the technique are warranted. CONTRIBUTION OF THE PAPER.

Objectives: Measure the prevalence and severity of disability, and examine disability risk factors among adults living with HIV in London, United Kingdom (UK). Methods: We conducted a quantitative cross-sectional study. The following self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), a disability item using the Equality Act disability definition (EADD), and demographic and HIV questionnaire. We calculated the proportion (95% Confidence Interval; CI) of “severe” and “moderate” disability as measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic and HIV characteristic questionnaire responses to assess potential risk factors of “severe” (EADD) and “moderate” (WHODAS scores ≥2) disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis. Results: Of 201 participants, 176 (87.6%) identified as men, with median age 47 years, and 194 (96.5%) virologically suppressed. Severe disability prevalence was 39.5% (n=79/201), 95% CI [32.5%, 46.4%]. Moderate disability prevalence was 70.5% (n=141/200), 95% CI [64.2%, 76.8%]. Uncertainty was the most severe HDQ disability domain. The HIV characteristic of late HIV diagnosis was a risk factor for severe disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. The social determinants of health economic inactivity [OR 2.79; CI 1.08, 7.21] and receiving benefits [OR 2.87; CI 1.05, 7.83] were risk factors for “severe” disability. Economic inactivity [OR 3.14; CI 1.00, 9.98] was a risk factor for “moderate” disability. Economic inactivity, receiving benefits, and having no fixed abode were risk factors (P≤0.05) across HDQ disability domains; physical, mental and emotional, difficulty with day-to-day activities, and challenges to social participation. Personal factors of identifying as a woman and being aged <50 years were risk factors ( P ≤0.05) for HDQ disability domains; mental and emotional, uncertainty, and challenges with social participation. Conclusions: People living with well-controlled HIV in London UK experienced multi-dimensional and episodic disability. Results help to better understand the prevalence, severity, and risk factors of disability experienced by adults living with HIV, identify areas to target interventions, reduce disability, and optimise health and function.