Efficacy of a peer-led exercise and education programme combined with a therapeutic relationship to manage pain in rural amaXhosa women living with HIV/AIDS compared to a therapeutic relationship alone

Abstract

Background: Pain is the one of the most prevalent symptoms in people living with Human Immunodeficiency Virus/Acquired Immune Disease Syndrome (HIV/AIDS) and is largely undermanaged. In urban amaXhosa women living with HIV/AIDS (LWHA), the 'Positive Living' (PL) programme has been identified as an effective non-pharmacological intervention for managing pain and may be affected by an empathetic therapeutic relationship. As a high prevalence of pain is likely to exist in rural amaXhosa women LWHA in South Africa, research is warranted on these two interventions amongst this population. Aim: To determine the effect of the combined PL programme and therapeutic relationship intervention (PL intervention), in comparison to a therapeutic relationship intervention (TR intervention) alone on pain severity, pain interference, symptoms of depression, health-related quality of life (HRQoL), self-efficacy and physical function in rural amaXhosa women LWHA. Method: A single-blind randomised trial was conducted using a sample of convenience. Interviewer administered questionnaires and functional tests at Baseline and at Weeks 4, 8, 12 and 24 were collected for the PL and TR intervention groups. Regression analysis determined the change of the primary outcomes, pain severity and interference, and secondary outcomes over the 24 weeks of the study. Results: Forty-nine amaXhosa women LWHA participated in the study. The PL programme and the data collection points were poorly attended by both groups. The pain severity and pain interference scores improved significantly in the PL (n = 26) and TR (n = 23) intervention groups over the 24 weeks of the study, with no significant differences between intervention groups. Symptoms of depression, HRQoL, self-efficacy and six of eight physical function tests were also significantly improved in the PL and TR intervention groups and, with the exception of self-efficacy, no significant differences existed between intervention groups. Conclusion: The therapeutic relationship appears to be sufficient to manage pain in rural amaXhosa women LWHA and should therefore be recognised as a necessary intervention to provide effective and adequate pain management