AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #374 - A preliminary investigation of the use of a ‘basket’ of outcome measures within a rehabilitation service for HIV-positive adults diagnosed with HIV-related neurocognitive impairment
Authors: Presenting Author: Dr. Simon Rackstraw - MILDMAY HOSPITAL UK
Additional Authors: Miss Emma Wicks, Ms Camilla Hawkins,
Aim: Mildmay provides an HIV in-patient assessment and rehabilitation service for adults, specialising in those with HIV related neurological disorders. Patients are referred from across the UK and the demographics reflect the national pattern of the HIV epidemic in the UK. Many of these patients are new-late diagnoses or those who have been lost to follow up. Patients present with a complex combination of physical, cognitive and psychosocial problems. There is a paucity of outcome measures which enable evaluation of the complex needs of these patients. In 1995 the British Society of Rehabilitation Medicine recognised that, “no single instrument can be used to measure disability”, consequently introducing and recommending the use of a ‘basket’ of measures. Therefore, we decided to use a set of tools to explore their application in evaluating rehabilitation outcomes in our cohort of patients with HIV-related neurological disorders
Method / Issue: The multidisciplinary team completed the Barthel, Health of the Nation Outcome Score – Acquired Brain Injury (HoNOS-ABI) and Northwick Park Dependency Score (NPDS) outcome measures on admission and again at discharge. Routine cognitive screening tests were also completed on admission including the Mini Mental State Examination (MMSE), the International HIV Dementia Scale (IHDS) and the HIV Dementia Scale (HDS). Admission and discharge data was collected for 19 patients with a range of admission lengths from 2-18 weeks (mean 6.5 weeks). Referral diagnoses included a range of HIV related neurological disorders including HIVE and cerebral opportunistic infections. All patients were referred from acute or residential settings or with difficulty coping in the community. Routine cognitive screening tests on admissions showed average scores of: MMSE = 22.6 (range 11-30), IHDS = 6.9 (range 0-11.5) and HDS = 7.4 (range0.5-16).
Results / Comments: Following interventions, 18/19 patients were discharged into the community, 4/19 of these without the need for any social support. The Barthel and NPDS showed improvements between admission and discharge scores for diagnoses where the principle impairments were physical. The range of improvement on the NPDS was 0-24, (average change 8.76). The Barthel scores reflect the NPDS, half of the patients scored showed a change of between 5 and 60 points. The HoNOS-ABI scores show showed improvements between admission and discharge scores for diagnoses where the principle impairments were cognitive. The range of improvement on the HoNOS-ABI was between 2-21 points (average initial score 17.4, average discharge score 9.7). These changes in scores reflected the improvements in physical and cognitive domains seen by the multidisciplinary team after intervention.
Discussion: There appears to be some correlation between the improved outcome scores and improved functional abilities of the patients. No single score adequately reflects the outcomes achieved with these patients, therefore a ‘basket' of measures approach is needed when working with these physically and cognitively impaired patient cohort. The use of the Barthel appears to be unnecessary if other measures are being used that account for physical impairments such as the NPDS. Further consideration needs to be given to capturing psychosocial wellbeing and mood.
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