1
|
O'Brien KK, Ibáñez-Carrasco F, Birtwell K, Donald G, Brown DA, Eaton AD, Kasadha B, Stanmore E, St Clair-Sullivan N, Townsend L, Vera JH, Solomon P. Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative. AIDS Res Ther 2023; 20:86. [PMID: 38071351 PMCID: PMC10709904 DOI: 10.1186/s12981-023-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. METHODS We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. RESULTS Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. CONCLUSION Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.
Collapse
Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada.
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, M5G 1V7, Canada.
| | - Francisco Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kelly Birtwell
- Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Graeme Donald
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrew D Eaton
- Faculty of Social Work, University of Regina, Saskatoon Campus, The Concourse, 111-116 Research Drive, Saskatoon, SK, S7N 3R3, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Emma Stanmore
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
- Healthy Ageing Research Group (HARG), University of Manchester, Manchester, United Kingdom
| | - Natalie St Clair-Sullivan
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Liam Townsend
- Department of Infectious Diseases, St James's Hospital, Dublin 8, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Hospital, Dublin 8, Dublin, Ireland
| | - Jaime H Vera
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, East Sussex, United Kingdom
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, L8S 1C7, Canada
| |
Collapse
|
2
|
O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
Collapse
Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Vajravelu S, O'Brien KK, Moll S, Solomon P. Exploring the disability experiences of South Asian Women living with HIV in Southern Ontario, Canada. Disabil Rehabil 2023; 45:434-440. [PMID: 35168465 DOI: 10.1080/09638288.2022.2037741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Given the steady rise in HIV incidence among South Asian women in Canada their health-related challenges and disability are not well understood. Our aim was to understand the "lived experiences" of disability among South Asian women living with HIV in Southern Ontario, Canada. METHODS We conducted a qualitative study using an interpretive phenomenological approach. We recruited immigrant South Asian women living with HIV in Ontario and conducted one-on-one semi structured interviews. Following the first interview, participants were invited to participate in a second interview. Interviews were audio recorded and transcribed verbatim. RESULTS Eight participants completed the first interview; six completed a second interview (14 interviews total). The mean age of participants was 47.1 years (standard deviation (sd) = 5.8) and mean length of time since HIV diagnosis was 15.1 years (sd = 6.7). We identified two overarching themes, "experiencing disability" and "experiencing discrimination". Apart from the physical and mental health impairments, the complex intersection of illness, gender, ethnicity, HIV-stigma and discrimination influenced disability experiences. CONCLUSION Understanding the disability experiences of marginalized women living with HIV through a phenomenological lens can help to facilitate the development of culturally safe treatment approaches and health care policies to lessen disability and improve their quality of life.Implications for rehabilitationDeveloping culturally safe treatment approaches may help to improve rehabilitation service provision for ethnically and culturally diverse populations.Rehabilitation professionals need to adopt a trauma-informed care when treating people living with HIV.Rehabilitation professionals should consider cultural safety by considering the role of religion, dependency, and gendered-power relations while treating South Asian women living with HIV.
Collapse
Affiliation(s)
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| |
Collapse
|
4
|
Ibeneme SC, Uwakwe VC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun TA, Ezuma AD, Okonkwo UP, Fortwengel G. Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:469. [PMID: 35578192 PMCID: PMC9109396 DOI: 10.1186/s12879-022-07145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Symptoms of depression are prevalent in people living with human immune deficiency virus/acquired immune deficiency syndrome (PLWHA), and worsened by lack of physical activity/exercises, leading to restriction in social participation/functioning. This raises the question: what is the extent to which physical exercise training affected, symptoms of depression, physical activity level (PAL) and social participation in PLWHA compared to other forms of intervention, usual care, or no treatment controls? Method Eight databases were searched up to July 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Only randomised controlled trials involving adults who were either on HAART/HAART-naïve and reported in the English language, were included. Two independent reviewers determined the eligibility of the studies, extracted data, assessed their quality, and risk of bias using the Physiotherapy Evidence Database (PEDro) tool. Standardised mean difference (SMD) was used as summary statistics for the mean primary outcome (symptoms of depression) and secondary outcomes (PAL and social participation) since different measuring tools/units were used across the included studies. Summary estimates of effects were determined using a random-effects model (I2). Results Thirteen studies met the inclusion criteria with 779 participants (n = 596 participants at study completion) randomised into the study groups, comprising 378 males, 310 females and 91 participants with undisclosed gender, and with an age range of 18–86 years. Across the studies, aerobic or aerobic plus resistance exercises were performed 2–3 times/week, at 40–60 min/session, and for between 6-24 weeks, and the risk of bias vary from high to low. Comparing the intervention to control groups showed significant difference in the symptoms of depression (SMD = − 0.74, 95% confidence interval (CI) − 1.01, − 0.48, p ≤ 0.0002; I2 = 47%; 5 studies; 205 participants) unlike PAL (SMD = 0.98, 95% CI − 0.25, 2.17, p = 0.11; I2 = 82%; 2 studies; 62 participants) and social participation (SMD = 0.04, 95% CI − 0.65, 0.73, p = 0.91; I2 = 90%; 6 studies; 373 participants). Conclusion Physical exercise training could have an antidepressant-like effect in PLWHA but did not affect PAL and social participation. However, the high heterogeneity in the included studies, implies that adequately powered randomised controlled trials with clinical/methodological similarity are required in future studies. Trail Registration number INPLASY202040048. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07145-4.
Collapse
Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa. .,University of Nigeria, University of Nigeria Centre for Clinical Trials (UNNCET), 1 College Road, New Layout, Enugu, 400001, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences & Technology, King David University of Medical Sciences, Amasir i- Afikpo Road, Uburu, 491101, Ebonyi State, Nigeria.
| | - Victor Chukwuebuka Uwakwe
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Franklin Onyedinma Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Division of Exercise Science and Sports Medicine, University of Cape Town/Sports Science, Institute of South Africa, Boundary Road, Newlands, Cape Town, 7725, Western Cape, South Africa
| | - Tunde Adedayo Ajidahun
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Amarachi Destiny Ezuma
- Department of Physiotherapy, University of Nigeria Teaching Hospital, KM 35 Enugu Port-Harcourt Expressway, Ituku/Ozalla, 400001, Enugu, Nigeria
| | - Uchenna Prosper Okonkwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, Nnamdi Azikiwe University, Okofia, Nnewi Campus, Nnewi, 435101, Anambra State, Nigeria
| | - Gerhard Fortwengel
- Fakultat III, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza, Hannover, 30539, Lower Saxony, Germany
| |
Collapse
|
5
|
Vader K, Chan Carusone S, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Examining the Utility of the HIV Disability Questionnaire (HDQ) in Clinical Practice: Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2022; 21:23259582221079148. [PMID: 35175151 PMCID: PMC8859678 DOI: 10.1177/23259582221079148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Our aim was to examine the utility of the HIV Disability Questionnaire (HDQ), a patient-reported outcome measure for use in clinical practice from the perspectives of people living with HIV (PLWH) and healthcare providers. We conducted a qualitative descriptive study. Fifteen PLWH and five healthcare providers participated in an interview, of which ten PLWH participated in a follow-up focus group discussion. The HDQ has value in clinical practice, including its role in assessing disability, facilitating communication, tailoring treatments, and guiding referrals. Strengths of the HDQ included its comprehensiveness, relevance of domains, and importance of specific items. Concerns related to length of the HDQ, the potential for some items to trigger emotional response, and negative connotations with the term ‘disability.’ Recommendations for HDQ implementation included the importance of score interpretability, shortening the questionnaire, and tailoring administration to the individual. Results suggest the HDQ possesses clinical utility with PLWH and healthcare providers.
Collapse
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, 4257Queen's University, Kingston, ON, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, ON, Canada.,Department of Family and Community Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,Rehabilitation Science Institute, 7938University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, 7938University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Vader K, Carusone SC, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Strengths and Challenges of Implementing Physiotherapy in an HIV Community-Based Care Setting: A Qualitative Study of Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2021; 20:23259582211005628. [PMID: 33779374 PMCID: PMC8010811 DOI: 10.1177/23259582211005628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.
Collapse
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| |
Collapse
|
7
|
Alford K, Daley S, Banerjee S, Vera JH. Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study. PLoS One 2021; 16:e0251944. [PMID: 34010362 PMCID: PMC8133427 DOI: 10.1371/journal.pone.0251944] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.
Collapse
Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- * E-mail:
| | - Stephanie Daley
- Centre for Dementia Studies, University of Sussex, Falmer, East Sussex, United Kingdom
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jaime H. Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
| |
Collapse
|
8
|
Bui KD, Wamsley CA, Shofer FS, Kolson DL, Johnson MJ. Robot-Based Assessment of HIV-Related Motor and Cognitive Impairment for Neurorehabilitation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:576-586. [PMID: 33534709 PMCID: PMC7987220 DOI: 10.1109/tnsre.2021.3056908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is a pressing need for strategies to slow or treat the progression of functional decline in people living with HIV. This paper explores a novel rehabilitation robotics approach to measuring cognitive and motor impairment in adults living with HIV, including a subset with stroke. We conducted a cross-sectional study with 21 subjects exhibiting varying levels of cognitive and motor impairment. We tested three robot-based tasks – trajectory tracking, N-back, and spatial span – to assess if metrics derived from these tasks were sensitive to differences in subjects with varying levels of executive function and upper limb motor impairments. We also examined how well these metrics could estimate clinical cognitive and motor scores. The results showed that the average sequence length on the robot-based spatial span task was the most sensitive to differences between various cognitive and motor impairment levels. We observed strong correlations between robot-based measures and clinical cognitive and motor assessments relevant to the HIV population, such as the Color Trails 1 (rho = 0.83), Color Trails 2 (rho = 0.71), Digit Symbol – Coding (rho = 0.81), Montreal Cognitive Assessment – Executive Function subscore (rho = 0.70), and Box and Block Test (rho = 0.74). Importantly, our results highlight that gross motor impairment may be overlooked in the assessment of HIV-related disability. This study shows that rehabilitation robotics can be expanded to new populations beyond stroke, namely to people living with HIV and those with cognitive impairments.
Collapse
|
9
|
Bui KD, Wamsley CA, Shofer FS, Kolson DL, Johnson MJ. Robot-based assessment of HIV-related motor and cognitive impairment for neurorehabilitation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33173932 PMCID: PMC7654928 DOI: 10.1101/2020.10.30.20223172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There is a pressing need for strategies to slow or treat the progression of functional decline in people living with HIV. This paper explores a novel rehabilitation robotics approach to measuring cognitive and motor impairment in adults living with HIV, including a subset with stroke. We conducted a cross-sectional study with 21 subjects exhibiting varying levels of cognitive and motor impairment. We developed three robot-based tasks – trajectory tracking, N-back, and spatial span – to assess if metrics derived from these tasks were sensitive to differences in subjects with varying levels of executive function and upper limb motor impairments. We also examined if these metrics could estimate clinical cognitive and motor scores. The results showed that the average sequence length on the robot-based spatial span task was the most sensitive to differences between subjects’ cognitive and motor impairment levels. We observed strong correlations between robot-based measures and clinical cognitive and motor assessments relevant to the HIV population, such as the Color Trails 1 (rho = 0.83), Color Trails 2 (rho = 0.71), Digit Symbol – Coding (rho = 0.81), Montreal Cognitive Assessment – Executive Function subscore (rho = 0.70), and Box and Block Test (rho = 0.74). Importantly, our results highlight that gross motor impairment may be overlooked in the assessment of HIV-related disability. This study shows that rehabilitation robotics can be expanded to new populations beyond stroke, namely to people living with HIV and those with cognitive impairments.
Collapse
Affiliation(s)
- Kevin D Bui
- Rehabilitation Robotics Lab and Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Carol A Wamsley
- Penn Institute for Rehabilitation Medicine, Philadelphia, PA 19146 USA
| | - Frances S Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Dennis L Kolson
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Michelle J Johnson
- Rehabilitation Robotics Lab, Department of Physical Medicine and Rehabilitation, and Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104 USA
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
Collapse
Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
11
|
Restall G, Simms A, Etcheverry E, Roger K, James D, Roddy P, Porch W, Potts J, Skitch D, Yates T. Supporting choices about HIV disclosure in the workplace: A cross-Canada survey of strategies. Work 2020; 64:731-741. [PMID: 31815713 PMCID: PMC7029371 DOI: 10.3233/wor-193035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: People living with human immunodeficiency virus (HIV) often make highly personal decisions about whether or not to disclose their HIV status in the workplace. OBJECTIVE: We aimed to determine current practices that support people living with HIV to make workplace disclosure decisions and to understand factors that affect disclosure decision-making. METHODS: Ninety-four people who provide health, social and peer-based services responded to an on-line survey about their experiences supporting workplace disclosure decisions of employees living with HIV. RESULTS: Respondents identified a range of strategies to support workplace disclosure decision-making. One-third of respondents were only a little or not confident in their abilities to support people in making disclosure decisions and 32% expressed little or no confidence in the resources available. Respondents working at HIV-specific organizations, as compared to respondents not working at those organizations, were more confident supporting people with disclosure decisions and in available resources, p < .05. Perceived barriers to disclosure decisions included stigma, lack of knowledge, and personal factors. Supports for decision-making resided within personal, workplace and societal contexts. CONCLUSIONS: The study provides important understanding about the complexity of disclosure decision-making and strategies that people living with HIV can use to address this complex issue.
Collapse
Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alexandria Simms
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Emily Etcheverry
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kerstin Roger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dawn James
- Nine Circles Community Health Centre, Winnipeg, MB, Canada (at the time of the study)
| | - Pumulo Roddy
- Sexuality Education Resource Centre, Winnipeg, MB, Canada
| | | | - Jeff Potts
- Canadian Positive People Network, Ottawa, ON, Canada (at the time of the study)
| | - Dave Skitch
- Toronto HIV/AIDS Network, Toronto, ON, Canada (at the time of the study)
| | | |
Collapse
|
12
|
O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Brown D, Ahluwalia P, Chan Carusone S, Baxter L, Emlet C, Restall G, Casey A, Ahluwalia A, Quigley A, Terpstra AR, Ononiwu N. Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC). AIDS Res Ther 2020; 17:21. [PMID: 32429973 PMCID: PMC7236512 DOI: 10.1186/s12981-020-00280-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. METHODS We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. RESULTS Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. CONCLUSIONS These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.
Collapse
Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation (IHPME), 155 College Street, 4th Floor, Toronto, ON Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | | | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- Cicely Saunders Institute, King’s College London, Bessemer Road, London, UK
| | - Darren Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Charles Emlet
- University of Washington, Tacoma, Social Work, 1900 Commerce Street, Tacoma, WA USA
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, R127 Rehab Building, Winnipeg, MB Canada
| | - Alan Casey
- Department of Physical Medicine and Rehabilitation, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB Canada
| | | | - Adria Quigley
- Faculty of Health, Dalhousie University, 5968 College Street, Room 316, Halifax, NS Canada
| | - Alex R. Terpstra
- Department of Psychology, 2136 West Mall, Room 2405, Vancouver, BC Canada
| | - Nkem Ononiwu
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| |
Collapse
|
13
|
DiVita MA, Mix JM, Shelly S, Beshers S. Characterization of inpatient rehabilitation outcomes among HIV/AIDS patients: a retrospective cohort study. AIDS Care 2020; 32:1363-1371. [PMID: 32308024 DOI: 10.1080/09540121.2020.1752889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT Survival time in HIV/AIDS patients has increased as a result of improved treatments, but many acquire functional impairments that may necessitate multidisciplinary medical rehabilitation. In the United States, inpatient rehabilitation facilities (IRF) provide this care, but outcomes are not well described in this population. We used the Uniform Data System for Medical Rehabilitation (UDSMR) database to describe 11,051 HIV/AIDS IRF patients; HIV/AIDS patients were grouped according to the following admission criteria: (1) HIV/AIDS as primary reason for admission (n = 225); (2) HIV/AIDS symptomatic comorbidity (n = 6569); and (3) HIV/AIDS asymptomatic comorbidity (n = 4257). We used standard descriptive statistics to summarize demographic, medical, rehabilitation, and discharge setting characteristics by group. When compared to patients with HIV/AIDS as a comorbidity, primary HIV/AIDS patients had worse outcomes. They made less functional change (25.1 versus 29.8 and 28.9, p < .001), went home less (73.8% versus 74.5% and 77.8%, p < .001) and to an acute care hospital more frequently (18.2% versus 13.9% and 10.1%, p < .001). These findings help to characterize the HIV/AIDS patient population who receive inpatient medical rehabilitation, which helps inform clinical care, and highlight the positive impact IRF care can make to minimize functional disability among chronic HIV/AIDS patients and possibly decrease costs of home health care.
Collapse
Affiliation(s)
- Margaret A DiVita
- Health Department, State University of New York at Cortland, Cortland, NY, USA
| | - Jacqueline M Mix
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Sandeep Shelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Sarah Beshers
- Health Department, State University of New York at Cortland, Cortland, NY, USA
| |
Collapse
|
14
|
Banda GT, Mwale G, Chimwala M, Malimusi L, Chisati E. Common impairments and functional limitations of HIV sequelae that require physiotherapy rehabilitation in the medical wards at Queen Elizabeth Central Hospital, Malawi: A cross sectional study. Malawi Med J 2020; 31:171-176. [PMID: 31839885 PMCID: PMC6895382 DOI: 10.4314/mmj.v31i3.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction The progression of human immunodeficiency virus (HIV) to acquired immune deficiency syndrome (AIDS) and the use of anti-retroviral therapy (ART) have resulted in a range of complications, which affect different body systems and result in functional limitations and disabling impairments. Objective To investigate HIV-related impairments and functional limitations that require physiotherapy rehabilitation in patients admitted to the medical wards at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methods This was a descriptive quantitative cross-sectional study involving the participation of 32 female (59.3%) and 22 male (40.7%) adults living with HIV and admitted to the medical wards at Queen Elizabeth Central Hospital. We collected data using a questionnaire that consisted of the World Health Organization Disability Assessment Schedule 2 (WHODAS2.0) and some demographic questions. Results were analysed using the Statistical Package for the Social Sciences (SPSS). Results Participation in society was the most frequently reported functional complication; the least common limitation was getting along with people (70.3%, n = 38 participants) and interaction with others (24%; n=13). Shortness of breath (55%; n=30), muscle weakness (44.4%; n=24) and joint and muscle pain (37%; n=20) were the most commonly reported impairments. Participation restriction in the society affected both males (77.3%) and females (70.7%). The least common limitation that required physiotherapy for both males and females was getting along with people (26.6% and 25%, respectively). On average, male and female participants had a disability severity score of 48.5±4.6 and 42.2±22.8, respectively. Conclusion Our data showed that there is a clear need for early intervention to halt or delay the progression of complications to avoid severe disability; this is not only good for the patient but also for the socioeconomic state of the nation. Timely and full functional assessment, as well as referral of people living with HIV/AIDS for rehabilitation, is an important step forwards.
Collapse
Affiliation(s)
- Gift Treighcy Banda
- University of Malawi, College of Medicine, Physiotherapy Department, Blantyre, Malawi
| | - Grace Mwale
- University of Malawi, College of Medicine, Physiotherapy Department, Blantyre, Malawi
| | - Michael Chimwala
- University of Malawi, College of Medicine, Physiotherapy Department, Blantyre, Malawi
| | - Linda Malimusi
- University of Malawi, College of Medicine, Physiotherapy Department, Blantyre, Malawi
| | - Enock Chisati
- University of Malawi, College of Medicine, Physiotherapy Department, Blantyre, Malawi
| |
Collapse
|
15
|
Abstract
Palm Springs, CA, is a retirement community with the highest prevalence of gay men living with HIV older than 50 years in the United States. Through a community-academic partnership, we explored the major health issues, resiliencies, and priority research topics related to HIV and aging. We conducted five community facilitated focus groups with different stakeholders, including two focus groups with older adults living with HIV, one with their caregivers, one with HIV-focused community-based organizations, and a joint focus group with researchers and HIV care providers. Using the rigorous and accelerated data reduction technique, five major themes emerged, which included long-term side effects of medication, social determinants of health, mental health, resiliencies, and involving community in research. These data are important for developing effective interventions, conducting useful and impactful research, and providing health care providers with the tools and knowledge to provide optimal care.
Collapse
|
16
|
Sundermann EE, Erlandson KM, Pope CN, Rubtsova A, Montoya J, Moore AA, Marzolini C, O'Brien KK, Pahwa S, Payne BA, Rubin LH, Walmsley S, Haughey NJ, Montano M, Karris MY, Margolick JB, Moore DJ. Current Challenges and Solutions in Research and Clinical Care of Older Persons Living with HIV: Findings Presented at the 9th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses 2019; 35:985-998. [PMID: 31373216 PMCID: PMC6862962 DOI: 10.1089/aid.2019.0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the era of effective antiretroviral therapy, the number of older people with HIV (PWH) is increasing, and those aging with HIV are experiencing an increasing burden of age-associated comorbidities. Life expectancy among older PWH is approaching that of demographically comparable HIV-uninfected (HIV-) adults. With this changing demographic of PWH come new challenges for researchers and clinicians in how to identify, address, and manage the complex interplay of treated HIV infection and aging-associated factors. In response to these challenges, the annual International Workshop on HIV and Aging was initiated in 2009 as a multidisciplinary platform for scientific discourse on the research and clinical complications arising from the aging population of PWH. The multidisciplinary nature of the workshop has resulted in a wide range of topics addressed over the past 9 years, from basic mechanisms in aging and HIV pathogenesis, to epidemiology of aging within large cohorts, interventions, and implementation of clinical programs. Herein, we summarize the key topics discussed at the 9th Annual International Workshop on HIV and Aging 2018, including "inflammaging," mitochondrial dysfunction, exercise interventions, HIV-associated neurocognitive impairment, metabolic dysfunction, menopause, and polypharmacy. In addition to recent developments in research and clinical care, we discuss open questions and future research directions required to better understand the interaction of HIV and aging.
Collapse
Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Center, Aurora, Colorado
- Department of Epidemiology, School of Public Health, University of Colorado-Anschutz Medical Center, Aurora, Colorado
| | - Caitlin N. Pope
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna Rubtsova
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jessica Montoya
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Alison A. Moore
- Division of Geriatrics and Gerontology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kelly K. O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- The Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Savita Pahwa
- Department of Microbiology and Immunology and the Miami CFAR, University of Miami Miller School of Medicine, Miami, Florida
| | - Brendan A.I. Payne
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monty Montano
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Maile Y. Karris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, Unviersity of California San Diego, San Diego, California
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Environmental Health and Engineering, and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| |
Collapse
|
17
|
Salbach NM, Solomon P, O'Brien KK, Worthington C, Baxter L, Blanchard G, Casey A, Chegwidden W, Dolan LA, Eby S, Gervais N. Design features of a guideline implementation tool designed to increase awareness of a clinical practice guide to HIV rehabilitation: A qualitative process evaluation. J Eval Clin Pract 2019; 25:648-655. [PMID: 30479024 DOI: 10.1111/jep.13070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES A comprehensive electronic guide (e-module) describing an interprofessional, evidence-informed approach to HIV rehabilitation was developed as an education resource for rehabilitation professionals. We developed a guideline implementation tool, consisting of a 10-week, case-based education intervention delivered by email, that was perceived to increase rehabilitation professionals' (occupational therapists (OTs), physical therapists (PTs), and speech language pathologists (SLPs)) knowledge and confidence to apply best practices in HIV rehabilitation. This study aimed to increase understanding of how the design of the guideline implementation tool facilitated increased awareness of and access to the e-module among rehabilitation professionals. METHODS We conducted a single group intervention study with rehabilitation professionals in Canada and the United Kingdom. Six case studies targeting HIV pathophysiology and associated conditions, an interprofessional approach to rehabilitation assessment and treatment, and psychosocial issues experienced by people living with HIV, were emailed to participants at 2-week intervals. Individual semi-structured interviews were conducted post-intervention. Interview transcripts were analysed using a descriptive qualitative approach. RESULTS Twenty-six individuals (17 from Canada, and 9 from the UK; 16 PTs, 7 OTs, 3 SLPs) were interviewed. One main theme related to design features of the intervention that facilitated learning and access to the e-module emerged. Subthemes highlighted features of the case-based intervention, including technical feasibility, terminology, formatting and layout, hyperlinks, number and frequency of case studies, and diverse and realistic case scenarios relevant to the learner's practice, that participants described as facilitating access to information and learning. CONCLUSION Electronically administered case studies were perceived as complementary knowledge tools that increased access to an evidence-informed guide to HIV rehabilitation. Findings provide guidance on using case studies as a guideline implementation tool to facilitate access to information and related resources to optimize learning.
Collapse
Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | | | | | - Alan Casey
- Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Will Chegwidden
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Sarah Eby
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Nicole Gervais
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
18
|
Brown DA, Simmons B, Boffito M, Aubry R, Nwokolo N, Harding R, O’Brien KK. Evaluation of the psychometric properties of the HIV Disability Questionnaire among adults living with HIV in the United Kingdom: A cross-sectional self-report measurement study. PLoS One 2019; 14:e0213222. [PMID: 31291243 PMCID: PMC6619602 DOI: 10.1371/journal.pone.0213222] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the HIV Disability Questionnaire (HDQ) among people living with HIV (PLHIV) in London, United Kingdom (UK). METHODS This is a cross-sectional measurement study. We recruited and administered the self-reported HDQ, seven criterion measures, and a demographic questionnaire with adults living with HIV accessing HIV care. We determined median and interquartile ranges (IQR) for disability presence, severity and episodic scores (range 0-100). We calculated Cronbach's alpha (α) Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores respectively (internal consistency reliability), smallest detectable change (SDC) for each HDQ severity item and domain (precision), and tested 36 a priori hypotheses assessing correlations between HDQ and criterion scores (construct validity). RESULTS Of N = 243 participants, all were male, median age 40 years, 94% currently taking antiretroviral therapy, and 22% living with ≥2 concurrent health conditions. Median HDQ domain scores ranged from 0 (IQR: 0,7) (difficulties with day-to-day activities domain) to 27 (IQR: 14, 41) (uncertainty domain). Cronbach's alpha for the HDQ severity scale ranged from 0.85 (95% Confidence Interval (CI): 0.80-0.90) in the cognitive domain to 0.93 (95%CI: 0.91-0.94) in the mental-emotional domain. The KR-20 statistic for the HDQ episodic scale ranged from 0.74 (95%CI: 0.66-0.83) in the cognitive domain to 0.91 (95%CI: 0.89-0.94) in the uncertainty domain. SDC ranged from 7.3-15.0 points on the HDQ severity scale for difficulties with day-to-day activities and cognitive symptoms domains, respectively. The majority of the construct validity hypotheses (n = 30/36, 83%) were confirmed. CONCLUSIONS The HDQ possesses internal consistency reliability and construct validity with varied precision when administered to males living with HIV in London, UK. Clinicians and researchers may use the HDQ to measure the nature and extent of disability experienced by PLHIV in the UK, and to inform HIV service provision to address the health-related challenges among PLHIV.
Collapse
Affiliation(s)
- Darren A. Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, Therapies Department, London United Kingdom
| | - Bryony Simmons
- Imperial College London, Faculty of Medicine, Department of Medicine, London, United Kingdom
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, Department of HIV Medicine, London, United Kingdom
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| |
Collapse
|
19
|
deBoer H, Cudd S, Andrews M, Leung E, Petrie A, Chan Carusone S, O'Brien KK. Recommendations for integrating physiotherapy into an interprofessional outpatient care setting for people living with HIV: a qualitative study. BMJ Open 2019; 9:e026827. [PMID: 31129584 PMCID: PMC6538079 DOI: 10.1136/bmjopen-2018-026827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To identify factors to consider when integrating physiotherapy (PT) into an interprofessional outpatient HIV care setting from the perspective of healthcare professionals and adults living with HIV. DESIGN We conducted a qualitative descriptive study using semi-structured interviews (healthcare professionals) and focus groups (adults living with HIV). We asked participants their perspectives on barriers, facilitators and strategies to accessing and participating in outpatient PT, important characteristics physiotherapists should possess working in outpatient HIV care, content and structure of PT delivery, and programme evaluation. RECRUITMENT AND SETTING We purposively sampled healthcare professionals based on their experiences working in interprofessional HIV care and recruited adults with HIV via word of mouth and in collaboration with an HIV-specialty hospital in Toronto, Canada. Interviews were conducted via Skype or in-person and focus groups were conducted in-person at the HIV-specialty hospital. PARTICIPANTS 12 healthcare professionals with a median of 12 years experience in HIV care, and 13 adults living with HIV (11 men and 2 women) with a median age of 50 years and living with a median of 6 concurrent health conditions in addition to HIV. RESULTS Overall impressions of PT in outpatient HIV care and factors to consider when implementing PT into an interprofessional care setting include: promoting the role of, and evidence for, PT in outpatient HIV care, structuring PT delivery to accommodate the unique needs and priorities of adults living with HIV, working collaboratively with a physiotherapist on the healthcare team and evaluating rehabilitation as a component of interprofessional care. CONCLUSIONS Multiple factors exist for consideration when implementing PT into an interprofessional outpatient HIV care setting. Results provide insight for integrating timely and appropriate access to evidence-informed rehabilitation for people living with chronic and episodic illness, such as HIV.
Collapse
Affiliation(s)
- Heather deBoer
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Cudd
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Andrews
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ellie Leung
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alana Petrie
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME); Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
Collapse
Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| |
Collapse
|
21
|
French D, Brink J, Bärnighausen T. Early HIV treatment and labour outcomes: A case study of mining workers in South Africa. HEALTH ECONOMICS 2019; 28:204-218. [PMID: 30345572 DOI: 10.1002/hec.3837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
This study examines whether labour outcomes of HIV-infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4+ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time. Also, we find that workers initiating antiretroviral therapy at CD4 ≥ 350 have an 8% lower risk of absence prior to treatment. Although many companies and the South African government have adopted universal test-and-treat policies aiming to initiate all HIV-infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.
Collapse
Affiliation(s)
- Declan French
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Jonathan Brink
- School of Economics, University of Cape Town, Cape Town, South Africa
| | - Till Bärnighausen
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
22
|
Schenk KD, Tun W, Sheehy M, Okal J, Kuffour E, Moono G, Mutale F, Kyeremaa R, Ngirabakunzi E, Amanyeiwe U, Leclerc-Madlala S. " Even the fowl has feelings": access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia. Disabil Rehabil 2018; 42:335-348. [PMID: 30282493 DOI: 10.1080/09638288.2018.1498138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities.Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors.Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and - by denying their circumstances - leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities.Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response.Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Implications for RehabilitationPersons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training.Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled.Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility.Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV.
Collapse
Affiliation(s)
- Katie D Schenk
- Department of Global and Community Health, George Mason University, Fairfax, VA
| | - Waimar Tun
- Department of Global and Community Health, George Mason University, Fairfax, VA
| | | | - Jerry Okal
- HIVCore/Population Council, Nairobi, Kenya
| | | | | | - Felix Mutale
- Zambia Agency for Persons with Disabilities, Lusaka, Zambia
| | - Rita Kyeremaa
- Ghana Federation of Disability Organisations, Accra, Ghana
| | | | | | | |
Collapse
|
23
|
Bui KD, Johnson MJ. Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke. J Neuroeng Rehabil 2018; 15:75. [PMID: 30107849 PMCID: PMC6092818 DOI: 10.1186/s12984-018-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.
Collapse
Affiliation(s)
- Kevin D. Bui
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
| | - Michelle J. Johnson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
24
|
Cresswell FV, Levett T. Specialist care of older adults with HIV infection in the UK: a service evaluation. HIV Med 2017; 18:519-524. [PMID: 28117544 DOI: 10.1111/hiv.12481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a clear trajectory towards cohort ageing in the UK. HIV infection is associated with an increased prevalence of traditionally age-related comorbidities and geriatric syndromes. Some HIV services have been proactive in innovating models that cater for adapting needs. We aimed to describe how widespread this practice is and what form such services take. METHODS We conducted an evaluation of the perceived need for and current provision of specialist ageing services, and the need for formal guidance on monitoring or treatment of older adults with HIV infection. A web-based questionnaire was sent to the audit lead at every British HIV Association (BHIVA)-registered HIV clinic. RESULTS A total of 102 clinics responded, with a broad geographical spread. Five of the 102 clinics have a clinician with an interest in ageing. Two dedicated HIV ageing services exist, practising different models. A quarter (23 of 98; 23%) of clinics reported a need for an ageing service, with three in development. The majority (65 of 95; 68%) supported dedicated guidance for monitoring in older adults, but fewer (39 of 94; 41%) felt that dedicated guidance on treatment was necessary. CONCLUSIONS We identified two existing and three proposed HIV ageing services. Another 20 clinics (20%) reported an unmet need for a specialist ageing service, suggesting that complex older adults may pose a management challenge. This is the first survey of its kind to attempt to describe the current landscape and opinion around such services. HIV-infected cohorts will continue to age and current models of care may be insufficient, which should prompt services, their users and commissioners to consider what models may best fit current and future demand.
Collapse
Affiliation(s)
- F V Cresswell
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - T Levett
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
25
|
Rachlis B, Burchell AN, Gardner S, Light L, Raboud J, Antoniou T, Bacon J, Benoit A, Cooper C, Kendall C, Loutfy M, Wobeser W, McGee F, Rachlis A, Rourke SB. Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada. AIDS Care 2016; 29:828-837. [PMID: 28027668 DOI: 10.1080/09540121.2016.1271389] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Continuous HIV care supports antiretroviral therapy initiation and adherence, and prolongs survival. We investigated the association of social determinants of health (SDH) and subsequent retention in HIV care in a clinical cohort in Ontario, Canada. The Ontario HIV Treatment Network Cohort Study is a multi-site cohort of patients at 10 HIV clinics. Data were collected from medical charts, interviews, and via record linkage with the provincial public health laboratory for viral load tests. For participants interviewed in 2009, we used three-category multinomial logistic regression to identify predictors of retention in 2010-2012, defined as (1) continuous care (≥2 viral loads ≥90 days in all years; reference category); (2) discontinuous care (only 1 viral load/year in ≥1 year); and (3) a gap in care (≥1 year in 2010-2012 with no viral load). In total, 1838 participants were included. In 2010-2012, 71.7% had continuous care, 20.9% had discontinuous care, and 7.5% had a gap in care. Discontinuous care in 2009 was predictive (p < .0001) of future retention. SDH associated with discontinuous care were Indigenous ethnicity, being born in Canada, being employed, reporting hazardous drinking, and non-injection drug use. Being a heterosexual male was associated with having a gap in care, and being single and younger were associated with discontinuous care and a gap in care. Various SDH were associated with retention. Care discontinuity was highly predictive of future gaps. Targeted strategic interventions that better engage those at risk of suboptimal retention merit exploration. ABBREVIATIONS AOR: adjusted odds ratio; ART: antiretroviral therapy; AUDIT: Alcohol Use Disorders Identification Test; CES-D: Center for Epidemiologic Studies Depression Scale; CIs: confidence intervals; HIV: human immunodeficiency virus; IQR: interquartile range; MSM: men who have sex with men; NA-ACCORD: North American AIDS Cohort Collaboration on Research and Design; OCS: Ontario HIV Treatment Network Cohort Study; OHTN: Ontario HIV Treatment Network; OR: odds ratio; PHOL: Public Health Ontario Laboratories; REB: Research Ethics Board; SDH: social determinants of health; US: United States.
Collapse
Affiliation(s)
- Beth Rachlis
- a Ontario HIV Treatment Network , Toronto , Canada.,b Division of Clinical Public Health, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Ann N Burchell
- c Division of Epidemiology , Dalla Lana School of Public Health, University of Toronto , Toronto , Canada.,d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.,e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Sandra Gardner
- g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,h Rotman Research Institute , Baycrest, Toronto , Canada
| | - Lucia Light
- a Ontario HIV Treatment Network , Toronto , Canada
| | - Janet Raboud
- g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,i Toronto General Research Institute, University Health Network , Toronto , Canada
| | - Tony Antoniou
- d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.,e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Jean Bacon
- a Ontario HIV Treatment Network , Toronto , Canada
| | - Anita Benoit
- j Women's College Research Institute, Women's College Hospital , Toronto , Canada
| | - Curtis Cooper
- k Ottawa Hospital Research Institute , Ottawa , Canada
| | - Claire Kendall
- l Bruyère Research Institute , Ottawa , Canada.,m Department of Family Medicine , University of Ottawa , Ottawa , Canada
| | - Mona Loutfy
- n Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , Toronto , Canada.,o Department of Medicine , Women's College Research Institute, Women's College Hospital , Toronto , Canada.,p Department of Medicine , University of Toronto , Toronto , Canada
| | - Wendy Wobeser
- q Department of Medicine , Queen's University , Kingston , Canada.,r Hotel Dieu Hospital , Kingston , Canada
| | - Frank McGee
- s AIDS Bureau, Ontario Ministry of Health and Long Term Care , Toronto , Canada
| | - Anita Rachlis
- p Department of Medicine , University of Toronto , Toronto , Canada.,t Sunnybrook Health Science Centre , Toronto , Canada
| | - Sean B Rourke
- a Ontario HIV Treatment Network , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,u Department of Psychiatry , University of Toronto , Toronto , Canada
| | -
- a Ontario HIV Treatment Network , Toronto , Canada
| |
Collapse
|
26
|
Moreh E, Israel S, Korem M, Meiner Z. Rehabilitation outcome of progressive multifocal leukoencephalopathy in HIV-positive patients: a report of two cases. Disabil Rehabil 2016; 39:1893-1896. [PMID: 27539012 DOI: 10.1080/09638288.2016.1211754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the rehabilitation treatment and outcome of progressive multifocal leukoencephalopathy (PML) in the context of Human Immunodeficiency Virus (HIV). METHOD The medical history of two HIV-positive patients with PML was reviewed; information on their neurological impairments, rehabilitation treatment and outcome was gathered. RESULTS The patients, a 47-year-old married man and a 34-year-old single man, both suffered from dense right hemiplegia and motor aphasia. Their rehabilitation course was delayed and prolonged: they were suitable for intensive multidisciplinary rehabilitation only 8 months or more after the initial presentation. Their treatment in outpatient rehabilitation daycare three times a week, that lasted 7 months on average, resulted in slow and steady functional improvement. At the end of the rehabilitation treatment, both patients were living at home, able to express themselves, and able to walk independently with an assistive device. They remained with moderate disability (modified Rankin scale of 3). CONCLUSION PML patients require prolonged multidisciplinary rehabilitation treatment; however, considerable progress can be achieved. Implications for Rehabilitation Progressive multifocal leukoencephalopathy (PML) is a disabling disease occurring in particular in the context of Human Immunodeficiency Virus (HIV). Presently a growing number of HIV-positive PML patients eventually survive the disease and remain with severe neurological impairments. PML patients require prolonged multidisciplinary rehabilitation treatment, and considerable progress can be achieved.
Collapse
Affiliation(s)
- Elior Moreh
- a Department of Physical Medicine & Rehabilitation , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Sarah Israel
- b Department of Internal Medicine , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Maya Korem
- c Department of Clinical Microbiology and Infectious Diseases , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Zeev Meiner
- a Department of Physical Medicine & Rehabilitation , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.,d Department of Neurology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| |
Collapse
|
27
|
Brown D, Claffey A, Harding R. Evaluation of a physiotherapy-led group rehabilitation intervention for adults living with HIV: referrals, adherence and outcomes. AIDS Care 2016; 28:1495-1505. [PMID: 27264319 DOI: 10.1080/09540121.2016.1191611] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
HIV is characterised by episodes of disability. We report a novel, hospital outpatient rehabilitation intervention, combining physiotherapy-led group exercise and education for people living with HIV (PLWH). This observational study evaluated routine delivery of the 10-week intervention in terms of referral patterns, rehabilitation goals, intervention adherence and change in patient outcomes. Measurements at baseline & 10 weeks included locomotor performance (6 minute walk test; 6MWT), flexibility, upper and lower limb strength and health related quality of life (HRQOL). Adherence was defined as attending ≥8/20 sessions, with reasons for non-adherence identified in retrospective telephone interviews. Goal Attainment Scale measured progression to individual goals. Total 92 referrals were mostly for musculoskeletal (25.0%), oncological (19.6%) or cardio-metabolic (18.5%) reasons, and mostly male (81.5%), Caucasian (70.7%) and older (mean 51.5 years). Common themed rehabilitation goals included improving body image, participation, mobility, health/fitness and function. Adherence was achieved by 42 (46%) patients, with open access utilised by 34 patients, returning (n = 19) or restarting when non-adherent (n = 15). Post-intervention measurements collected for 37 (40%) patients demonstrated improvements in 6MWT distance (p < .001), flexibility (p < .001), strength in triceps (p < .001), biceps (p < .001), Lattisimus Dorsi (p < .001), shoulder-press (p < .001), chest-press (p < 0.001), and leg-press (p < 0.001). HRQOL improved in total score (p < .001), physical (p < .001), emotional (p < .001) and functional (p = .065) subscales. Extent of goal achievement demonstrated 83% of goals was "expected" (n = 57), "somewhat more" (n = 31) or "much more" (n = 14). Reasons for non-adherence from 21 telephone interviews identified physical health challenges, individual factors and time or location issues. This novel rehabilitation approach for PLWH improved function, HRQOL and goal attainment among those completing the intervention. Sub-optimal adherence likely relates to episodic disability.
Collapse
Affiliation(s)
- Darren Brown
- a Therapies Department , Chelsea and Westminster Hospital , London , UK
| | - Austin Claffey
- b School of Health & Social Care, London South Bank University , London , UK
| | - Richard Harding
- c Department of Palliative Care, Policy & Rehabilitation , King's College London, Cicely Saunders Institute , London , UK
| |
Collapse
|
28
|
Livelli A, Orofino GC, Calcagno A, Farenga M, Penoncelli D, Guastavigna M, Carosella S, Caramello P, Pia L. Evaluation of a Cognitive Rehabilitation Protocol in HIV Patients with Associated Neurocognitive Disorders: Efficacy and Stability Over Time. Front Behav Neurosci 2015; 9:306. [PMID: 26635558 PMCID: PMC4644912 DOI: 10.3389/fnbeh.2015.00306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/30/2015] [Indexed: 11/13/2022] Open
Abstract
The primary aim of the present study was to evaluate the efficacy and stability over time of a cognitive rehabilitation protocol (restorative and compensatory approach) in HIV/AIDS patients with HIV-associated Neurocognitive Disorder (HAND). At baseline, 32 HIV/AIDS patients (16 with and 16 without HAND) were assessed with a neuropsychological battery (i.e., pre-assessment) consisting of 22 tests covering eight cognitive domains. Then, the experimental group was administered over 4 months a cognitive rehabilitation protocol aimed at improving four cognitive domains by means of eight paper and pencil/computer-based exercises. The control group received guideline-adherent clinical care (i.e., standard of care). At the end of the cognitive treatment, both groups were re-administered the neuropsychological battery (i.e., post-assessment). Additionally, 6 months after post-assessment, the experimental group was given the same neuropsychological battery (i.e., follow up-assessment). In order to test the efficacy of the cognitive rehabilitation protocol, we compared between groups the results of the neuropsychological battery at the pre- and post-assessments. In order to evaluate the stability over time, the effects of the cognitive rehabilitation protocol was examined comparing within the experimental group the results of the neuropsychological battery at post- and follow up-assessments. Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment. Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains. The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional). Overall, these findings support the efficacy and, to some extent, the stability over time of our cognitive rehabilitation protocol.
Collapse
Affiliation(s)
- Alessandro Livelli
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy ; SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy
| | - Gian Carlo Orofino
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino Torino, Italy
| | - Mariana Farenga
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | | | - Marta Guastavigna
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | | | - Pietro Caramello
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | - Lorenzo Pia
- SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy
| |
Collapse
|