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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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5.3 How do rehabilitation providers know if an outcome measure will be useful in practice?

Measurement properties are characteristics of a measure that can help determine whether the measure will be suitable for use in practice. There are four main measurement properties commonly seen in the literature (see Table 5.3).

Table 5.3: Descriptions of Measurement Properties

Measurement Property Description
Reliability The consistency of the measure and whether a measure (or questionnaire) is free from error.1

It is important that measures are reliable (or consistent) and able to differentiate measure scores between clients.

Validity How well the measure really measures what it is supposed to measure.1

Cronbach’s alpha is a measure of internal consistency reliability, otherwise referred to as homogeneity of the scale. This is a reflection of how well the items in the scale are measuring different aspects of the same concept.1 Nunnally suggests that a Cronbach’s alpha of > 0.9 is defined as acceptable for an instrument used with individual patients and a Cronbach alpha > 0.80 is defined as acceptable for a clinical instrument used with a group of patients (i.e., used in a research project).2

For example, does the HIV Symptom Index,3 developed to measure symptom presence and severity, really measure this construct or are there other HIV symptoms that people living with HIV might experience not captured in this questionnaire?

Responsiveness Ability for a measure to detect any change in a client over time if a change has occurred.1 This property is relevant to evaluative types of measures.

A sensitive, or responsive, assessment enables the healthcare provider to detect small to large changes in the construct of interest.

For example, a rehabilitation provider might be interested in knowing whether participation in a six-week aerobic exercise program has an impact on the Health-Related Quality of Life of a client.

Interpretability Meaning of the scores or values associated with the outcome measures, i.e., what do the numbers really mean?

For example, what does a score of 82 on the Mental Health Summary Score of the Medical Outcomes Study Short Form (SF-36)4,5 mean for clients? What does it mean for treatment decisions in clinical practice?

Terms such as the minimal detectable change (MDC), or minimal clinically important difference (MCID) refer to interpretability, specifically the minimum score that reflects an important or clinical change (improvement or worsening) for a given measure.1,6

For example, the MCID for the six-minute walk test is 25 meters among people living with Chronic Obstructive Pulmonary Disease.7 If an individual improves their score on the test by 30 metres, this can be interpreted as a clinically important improvement in functional capacity.

Often measures do not have a clear MCID or MDC and rehabilitation providers are left trying to interpret what the scores on a given measure mean for specific clients and what the scores mean for decision-making in clinical practice.

1 Streiner DL, Norman GR. Health Measurement Scales – A practical guide to their development and use. 4th ed. New York: Oxford University Press. 2008.

2 Nunnally JC, Bernstein IH. Psychometric Theory. 3rd Ed. New York: McGraw Hill, 1994.

3 Justice AC, Holmes W, Gifford AL, Rabeneck L, Zackin R, Sinclair G, Weissman S, Neidig J, Marcus C, Chesney M, Cohn SE, Wu AW; Adult AIDS Clinical Trials Unit Outcomes Committee.

Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001 Dec;54 Suppl 1:S77-90. PubMed PMID: 11750213.

4 Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3130-9. Review. PubMed PMID: 11124729.

5 Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998 Nov;51(11):903-12. PubMed PMID: 9817107.

6 Beaton DE, Boers M, Wells GA. Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol. 2002 Mar;14(2):109-14. Review. PubMed PMID: 11845014.

7 Holland AE, Hill CJ, Rasekaba T, Lee A, Naughton MT, McDonald CF. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010 Feb;91(2):221-5. doi: 10.1016/j.apmr.2009.10.017. PubMed PMID: 20159125.

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