Multimodal Group Rehabilitation Improves Function in Postural Orthostatic Tachycardia Syndrome (POTS)

Research Objectives: To examine the effect of a multimodal group program on gait speed, grip strength, quality of life, daily life function, cognition, and fatigue in POTS.

Design: A retrospective, longitudinal analysis on 19 individuals with POTS. Testing at pre-intervention, post-intervention, and at three-month follow-up.

Setting: Outpatient therapy clinic at a community hospital

Participants: Inclusion criteria were English-speaking individuals with POTS, ages 18-60, who could walk at least three minutes without post-exertional malaise or an unmanaged psychiatric disorder. A convenience sample was recruited via electronic flyers on social media, paper flyers, and word-of-mouth through local providers in the community. A total of 23 participants met the criteria and began the program, and 20 completed the study and testing. Attrition was due to family emergency (1), schedule issues (1), health challenges not associated with the study (1), and one participant completed the training but did not attend follow-up testing. Analysis was conducted on 19 female participants, an average of 28.63 years (SD=11.03) old.

Interventions: The intervention included fifty-minute sessions over eight consecutive weeks. Each session involved education, movement, and mindful self-compassion. Education included lectures on non-pharmacologic management of POTS. Movement included Pilates and pole walking.

Main Outcome Measures: Lower Extremity Functional Sale, Rand 36-Item Health Survey, Modified Fatigue Impact Scale, Trail Making Test A & B, 10 Meter Walk Test, dynamometer

Results: Significant improvement was noted on several outcome measures, analyzed using a Wilcoxon signed-rank test comparing values at pre to three months post (follow-up). The multimodal group intervention improved grip strength in the dominant (Z=-2.864, p< 0.01) and non-dominant (Z=-3.006, p< 0.01) hand and gait speed at both the comfortable pace (Z=-2.373, p< 0.05) and fast pace (Z=-2.504, p< 0.05). Energy was improved in psychological (Z=-3.238, p=0.001), physical (Z=-2.305, p< 0.05), and cognitive (Z=-2.206, p< 0.05) fatigue. Cognitive performance increased most notably at the complex task (Z=-3.724, p< 0.001) along with function (Z=-1.962, p< 0.01). Quality of life significantly improved, including physical functioning (Z=-2.138, p< 0.05), emotional well-being (Z=-2.211, p< 0.05), role limitations due to physical health (Z=-1.975, p< 0.05), energy levels (Z=-3.354, p< 0.001), social functioning (Z=-2.663, p< 0.01), and general health (Z=-2.684, p< 0.01).

Conclusions: This cohort showed significant benefit from a multimodal group rehabilitation intervention for POTS in the areas of gait speed, grip strength, fatigue, cognition, function in daily life, and quality of life. Further studies are indicated with a larger number of participants to generalize to the clinical population.

Author(s) Disclosures: N/A