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E-Module

An HIV and Rehab Resource

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  • About
    • 1 – What is this resource about and who is it for?
    • 2 – Why was this resource created?
    • 3 – How can this resource be used?
    • 4 – Can this resource be used for teaching?
    • 5 – How was this resource developed?
    • 6 – Who contributed to developing this adapted resource?
    • 7 – Who funded the development of this resource?
    • 8 – Disclaimer
  • Section 1
    • 1.1 How is “rehabilitation” defined in this resource?
    • 1.2 How can rehabilitation help people living with HIV?
    • 1.3 How can the World Health Organization’s “ICF” help us think about rehabilitation for people living with HIV?
    • 1.4 How can the Episodic Disability Model help us think about rehabilitation for people living with HIV?
    • 1.5 Who provides rehabilitation for people living with HIV?
    • 1.6 Do rehabilitation providers need special skills or training to care for people living with HIV? If so, what?
    • 1.7 What roles do rehabilitation providers have related to HIV?
    • 1.8 When is rehabilitation clinical intervention useful along the HIV care continuum?
  • Section 2
    • 2.1 What do rehabilitation professionals need to know about the stages of HIV infection?
    • 2.2 What do rehabilitation providers need to know about CD4 count and viral load?
    • 2.3 What is the impact of HIV on body systems and why does this matter for rehabilitation providers?
    • 2.4 Who might rehabilitation providers treat?
    • 2.5 What do rehabilitation providers need to know about antiretroviral therapies?
  • Section 3
    • 3.1 What are the rehabilitation interventions that address impairments common among people living with HIV?
    • 3.2 What are the rehabilitation interventions that can address the activity limitations and participation restrictions common among people living with HIV?
    • 3.3 More information on the rehabilitation interventions available for people living with HIV
    • 3.4 – What do rehabilitation providers need to know about their patients’ beliefs and use of traditional healers, spiritual leaders and alternative therapies outside the formal medical system?
  • Section 4
    • 4.1: Intersectionality Theory in the Context of Rehabilitation
    • 4.2: Children and Youth
    • 4.3: HIV and Aging
    • 4.4: Substance Use
    • 4.5: Trauma
    • 4.6: Racialized Populations
    • 4.7: Indigenous Populations
    • 4.8: HIV, Sex and Gender
    • 4.9: HIV and COVID-19
    • 4.10: Is HIV itself a disability?
  • Section 5
    • 5.1 What are outcome measures?
    • 5.2 Why is it important to use outcome measures during rehabilitation with people living with HIV?
    • 5.3 How do rehabilitation providers know if an outcome measure will be useful in practice?
    • 5.4 What are floor and ceiling effects in outcome measurement?
    • 5.5 What is the difference between generic and HIV-specific outcome measures?
    • 5.6 How should you decide which outcome measures to use?
    • 5.7 How do you access a copy of an outcome measure?
    • 5.8 What are rehabilitation-related outcome measures that can be useful for people living with HIV?
  • Case Studies
    • Case #1 – Acute Care, Cardiorespiratory and Neurological
    • Case #2 – Musculoskeletal – Knee Pain
    • Case #3 – Aging, Cognition, Community, Stroke
    • Case #4 – Complex Case – Musculoskeletal, Episodic, Cardiorespiratory
    • Case #5 – Diabetes, Neuropathy, Substance Use
    • Case #6 – Transition from Paediatric to Adult Care
    • Supplemental Case Studies without Leading Questions
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5.2 Why is it important to use outcome measures during rehabilitation with people living with HIV?

HIV management can be complex, which demands a comprehensive continuum of care.

Given the complexity of care associated with rehabilitation of people living with HIV, key issues to be addressed include: “what works?”, “how can it be measured?”, “what can be used to measure that which works?”

Table 5.2: Purpose of outcome measures

Purpose Description
Descriptive Describes the state of a health construct at a point in time.

This description can be used to compare the client to other clients, or the general population.

For example, measuring activities of daily living or symptom severity at one point in time.

Predictive Used to predict outcome or make a prognosis, helps clinicians set treatment goals or discharge plans, and anticipate the need for home adjustments or community support.1,2

For example, using a balance scale to predict whether someone is at risk of falling.

Evaluative Useful for detecting the magnitude of change over time in an individual or group.3,4

For example, measuring health-related quality of life (HRQL) at two time points, such as before and after a six-week rehabilitation program to see if there are changes (improvement or worsening) in HRQL.

Discriminative Differentiates between patient groups and identifies differences in patients’ abilities.5

What would rehabilitation providers measure in people living with HIV?

There are many “things” (otherwise referred to as constructs or concepts) that health professionals might measure with clients. These health-related concepts exist at multiple levels. Some examples of these levels and the tools used to measure them are listed below:

Body structure and function:

  • Presence and bothersome nature of symptoms: HIV Symptom Index
  • Physical performance measures: Short Physical Performance Battery, Five Times Sit-to-Stand Test, Timed Up and Go Test, Six-Minute Walk Test, Community Balance and Mobility Scale
  • Fatigue: HIV Fatigue Scale
  • Depression: Centres for Epidemiologic Studies Depression Scale

Activity:

  • Activities of daily living: Assessment of Motor and Process Skills
  • Self-management self-efficacy: Perceived HIV Self-Management Scale
  • Function: Functional Assessment of HIV Infection

Social participation:

  • Social Support: Medical Outcomes Study Social Support Survey
  • Stigma: HIV Stigma Scale
  • Coping Response: Brief COPE Scale
  • Stress: HIV Stress Scale

Health-related quality of life:

  • Medical Outcomes Study Short Form Questionnaire
  • Medical Outcomes Study-HIV Health Survey
  • Multidimensional Quality of Life Questionnaire for HIV/AIDS
  • Patient Reported Outcomes Quality of Life-HIV

1 Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke 2002;33:2626–2630.

2 Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke – a critical review of the literature. Age Ageing 1996;25:479–489.

3 Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985;38:27–36.

4 Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chronic Dis 1986;39:897–906.

5 Brock KA, Goldie PA, Greenwood KM. Evaluating the effectiveness of stroke rehabilitation: choosing a discriminative measure. Arch Phys Med Rehabil 2002;83:92–99.

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