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.