Physiotherapy in Human T-Lymphotropic Virus 1 Infection: Comparison
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The human T-lymphotropic virus 1 (HTLV-1) is a retrovirus in the Retroviridae family that affects human blood T lymphocytes and can cause neurological disorders. This infection is characterized by silent, long-term persistence in the host. Physical therapy has been prescribed for neurological complications associated with HTLV-1 because it improves functional status, reduces symptoms, and positively impacts patients’ quality of life

  • human T-lymphotropic virus 1
  • HTLV-1

1. Introduction

The human T-lymphotropic virus 1 (HTLV-1) is a retrovirus in the Retroviridae family that affects human blood T lymphocytes and can cause neurological disorders. This infection is characterized by silent, long-term persistence in the host. Despite its irregular distribution, estimates suggest that at least 20 million people are infected with HTLV-1 worldwide [1[1][2][3][4][5],2,3,4,5], whereas, in Brazil, about two million people live with the infection, but its distribution is heterogeneous and varies geographically [3,6][3][6].
The development of serious diseases has been pointed out in association with the virus, such as adult T-cell leukemia/lymphoma (ATL) and tropical spastic paraparesis or HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The latter is characterized by the installation of classic motor disabilities in patients and the slow, progressive, and non-remitting inflammation of the spinal cord, which affects 4 to 5% of infected subjects, causing more proximal motor weakness, spasticity of the lower limbs (LLLL), pain and bladder, intestinal and sexual dysfunctions, and, consequently, functional limitations such as impaired walking, ascending and descending stairs, washing, dressing, and urinary continence [7].
Faced with these significant motor disabilities, physical therapy has been prescribed for neurological complications associated with HTLV-1 because it improves functional status, reduces symptoms, and positively impacts patients’ quality of life [8,9,10][8][9][10]. Considering the importance of implementing physical exercise programs, the development of protocols that can be performed at home provides an alternative for treatment and continued care to resolve health conditions. Professionals must constitute methodologies that successively stimulate patients, as well as the teaching–learning process. Strategies to encourage adherence and motivation are fundamental for the success of treatment performed at home without the direct guidance of a health professional [11].
Such protocols are envisaged as auxiliary strategies for patients with difficulties attending rehabilitation centers as they propose to enable their performance with the use of low-cost materials, promote autonomy and confidence, resume social roles, and seek to provide general data of health conditions associated with HTLV-1 in this population since the levels of evidence and the strength of recommendation for these protocols are yet to be well-established.
Observing the presence of neurological signs and symptoms in HTLV-1 carriers living in the municipality of Belém (PA) [12] in unfavorable socioeconomic conditions, alongside the greater involvement of older women in relation to their presence, their prevalence among the Brown/Black population [13,14,15,16,17[13][14][15][16][17][18],18], as well as the limitations of access to vacancies in therapeutic programs regulated by the Unified Health System [19], the use of new interventions (such as the home exercise program) to strengthen patients’ muscles, improve their flexibility and joint mobility, adjust their postural disorders, and enable economic and cognitive access to other platforms would positively impact these individuals’ quality of life.

2. Physiotherapy in Human T-Lymphotropic Virus 1 Infection

Although Brazil has a prominent place in scientific production in physical therapy for people with HTLV-1, this production is still in its infancy, mainly testing therapeutic procedures. A scientometric study on the subject only found 68 studies involving physical therapists, 21 of which were interventional [35][20]. The most tested therapeutic resources were individual and group functional exercises, including Pilates, home exercise booklets, virtual therapy, and proprioceptive neuromuscular facilitation. Therapeutic exercise protocols must be improved, especially regarding dosage and progression. On the one hand, individualized exercises, as in PNF, positively reduce spasticity and improve movement control and functionality levels, but they are isolated cases, as in Costa et al. (2018)’s work [9], which reported five cases of patients with HAM/TSP which, thus, may have a higher cost. Group exercises are more accessible, may include a professional assisting a group (which reduces costs), and include the aspect of sharing experiences among peers, as in Klautau (2020)’s work [22][21], which carried out a pilot study with eight patients divided into two groups, one of wheelchair users and the other with gait impairment. As in Mota (2017) [19] and Facchinetti (2013) [31][22], home exercises stimulate autonomy for self-care and generate access opportunities for those who are unable to participate in outpatient services. In view of this, the three modalities of therapeutic exercises should be tested in randomized clinical trials with a larger sample size and more detailed protocols, considering a reasonable follow-up time to enable the measurement of a larger effect size, produce better levels of recommendation, and provide greater security in its reproducibility. Home care has become one of the main pillars of providing services at different levels of health as it meets the needs of patients with chronic health conditions, improves quality of life by controlling signs and symptoms, and decreases the risk of complications. Thus, the effectiveness of the practice of home exercises after an injury demands that patients, family members, and caregivers understand the importance of therapy, thus reaching an adequate process with greater possibilities of good results [36][23]. Studies have been using the home approach for physical exercise, considering feasibility and long-term maintenance [37[24][25][26][27][28],38,39,40,41], with a more accessible approach to exercise plans that can be performed at home and without the use of special equipment. Home exercise programs are widely used as an alternative strategy for patients with different conditions, such as Parkinson’s disease [42][29], traumatic spinal cord injury [43[30][31][32],44,45], multiple sclerosis [46,47][33][34], Huntington’s disease [48][35], strokes [49,50][36][37], post-polio syndrome [51][38], cardiovascular diseases [52][39], etc. Home exercises remove the need for accessibility to training facilities [53][40], is cost-effective [54,55,56][41][42][43], and reduces barriers to commuting time [54][41]. Moreover, standardized home exercise protocols guided by socio-educational materials such as booklets have been found as effective treatments of chronic degenerative diseases, stimulating individuals’ autonomy to manage their condition [57,58,59,60,61][44][45][46][47][48]. Thus, gathering evidence with a broad review should precede actions that help prevent functional declines associated with HTLV-1, such as the implementation of public health programs aimed at HTLV-1 carriers without defined HAM/TSP.

3. Conclusions

More studies on physical therapy modalities aimed at people affected by HTLV-1 must be developed and tested in randomized clinical trials with a larger sample size and more detailed protocols. This entry can contribute to a safe and evidence-based home clinical practice and point out new paths in the production of health education technologies that are sensitive to the reality of this population.
 

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