Multimodal rehabilitation for postural orthostatic tachycardia syndrome (POTS)

Objectives: To examine (a) feasibility characteristics of the multimodal training program, (b) outcomes of the program, (c) participants’ integration of treatment for long-term outcomes, and (d) align the findings with occupational adaptation (OA) to refine the program.

Design: A retrospective analysis to determine feasibility, baseline function, and progress following treatment. Focus group analysis to determine themes for long-term outcomes and alignment with OA concepts.

Setting: Outpatient clinic

Subjects: Nineteen female participants, ages 18 - 53 (M = 28.63) completed the multimodal training program. Six out of 19 participated in the focus group.

Intervention: A 50-minute weekly training program across eight weeks using a multimodal approach including education, movement, and mindful self-compassion.

Outcome Measures: Participants completed demographic and medical history and assessment for baseline orthostatic intolerance. At pre-training, post-training, and follow-up testing participants completed the Modified Fatigue Impact Scale, Lower Extremity Functional Scale, Rand 36-Item Health Survey 1.0, Trail Making Test (A and B), Center for Epidemiologic Studies Depression Scale – Revised, 10 Meter Walk Test, and grip strength testing.

Results: At baseline, participants were significantly below norms in the areas of daily function (p < 0.001), grip strength (p ≤ 0.001) gait speed (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Between pre-training and three-month follow-up, participants showed significant improvement across function in daily life tasks (p < 0.01); grip strength in the dominant (p < 0.01) and non-dominant (p < 0.01) hands; gait speed (p < 0.05); levels of fatigue (p < 0.05); cognitive performance (p < 0.05); and quality of life (p < 0.05). Focus group themes revealed many successful outcomes and several areas of ongoing need, specifically around the themes of information, community, growth, and advocacy. The EnRich Life Model was created, utilizing the POTSabilities Method as informed by OA to demonstrate the adaptation process in POTS.

Conclusions: Individuals with POTS face functional challenges that can be significantly improved through multimodal rehabilitation. Specifically, the EnRich Life Model using the POTSabilities method demonstrates a process by which adaptation occurs to increase relative mastery. Opportunities for advocacy could optimize care and quality of life for patients with POTS.