Barcelona 2013
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| Abstract #43 - Theory and Overview | ||||
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Session: 14.1: Theory and Overview (Parallel) on Monday @ 14.30-16.00 in Raval Chaired by Richard Harding, Sheana Bull Authors: Presenting Author: Dr. Kelly O'Brien - University of Toronto, Canada |
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| Additional Authors: | ||||
| Aim: Adults aging with HIV are living with the physical, social and psychological consequences of HIV disease, long term treatment, and comorbidities associated with aging. Rehabilitation including occupational therapy, physical therapy and speech-language pathology, can assist in managing the health related challenges or disability associated with HIV and aging. Our aim was to develop clinical evidence-informed recommendations on rehabilitation for older adults living with HIV. | ||||
| Method / Issue: We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and aging, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. We searched for and included: a) highly relevant HIV-specific research addressing rehabilitation and aging and b) high-quality evidence (systematic reviews and meta-analyses) on the effectiveness of rehabilitation interventions for comorbidities commonly experienced by older adults aging with HIV (specifically bone and joint disorders, cancer, cardiovascular disease, mental health, neurocognitive decline, cardiopulmonary disease, diabetes). We extracted and synthesized relevant data from included studies to draft evidence-informed recommendations on rehabilitation for older adults aging with HIV. Draft specific recommendations were refined based on people living with HIV (PHA) and clinician?s values and preferences, reviewed by an inter professional team for GRADE (quality) rating and revision, and then circulated to a new group of PHAs and clinicians for external endorsement and final refinement. We then consolidated the detailed specific recommendations into overarching recommendations to broadly guide rehabilitation for older adults with HIV. | ||||
| Results / Comments: This synthesis yielded eight overarching and 52 detailed recommendations. Thirty-six detailed recommendations were derived from 108 moderate or high level research evidence articles (meta-analyses and systematic reviews) that described the effectiveness of rehabilitation interventions for adults living with health conditions that may be experienced by older adults with HIV. Recommendations address specific rehabilitation interventions across eight health conditions experienced by older adults with HIV: bone and joint disorders, cancer, stroke, cardiovascular disease, mental health, cognitive impairments, chronic obstructive pulmonary disease, and diabetes. Sixteen detailed recommendations were derived from 42 research evidence articles specific to rehabilitation for older adults with HIV. The quality of evidence from which these recommendations were derived was either low or very low, consisting primarily of narrative reviews or descriptive studies with small sample sizes. These recommendations address approaches to rehabilitation assessment and interventions, and contextual factors to consider with rehabilitation of older adults living with HIV. | ||||
| Discussion: We established eight overarching and 52 specific evidence-informed recommendations from a combination of low level evidence specific to HIV, aging and rehabilitation, and high level research evidence describing the effectiveness of rehabilitation interventions for comorbidities that may be experienced by older adults with HIV. PHA and clinician values and preferences were integral in developing these recommendations. These evidence-informed recommendations provide a comprehensive guide for rehabilitation with older adults with HIV and those who may present with comorbidities. Next steps will include knowledge translation of the evidence- recommendations to PHAs, AIDS service organizations, and clinicians working in areas of HIV, family practice, and gerontology. | ||||
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