Amsterdam 2015
Menu
AIDSImpact.com
Conference Details
Authors
International Committee
Plenary Speakers
Presenting Speakers
Programme
Sessions
Scientific Committee
Acknowledgements
| Abstract #2314 - Challenging situations | ||||
|
Session: 53.4: Challenging situations (Parallel) on Friday @ 11.00-12.30 in C002 Chaired by Heidi van Rooyen, Rich Wolitski Authors: Presenting Author: Dr Simon Rackstraw - MILDMAY MISSION HOSPITAL, United Kingdom |
||||
| Additional Authors: | ||||
| Aim: The aim was to investigate participation in therapy interventions within an inpatient rehabilitation setting. Improved medical management of HIV infection has transformed longevity, and led to expectations of near normal life expectancy. This contributes to a scenario where participation in everyday activities is important to promote quality-of-life, and well-being. Challenges that people living with HIV continue to face include multiple co morbidities and fluctuating health and function. Episodic disability is marked by fluctuating periods and degree of unpredictable wellness and disability (O’Brien et al, 2009). This unpredictability can challenge therapy delivery in that it may affect engagement in rehabilitation | ||||
| Method / Issue: Retrospective analysis (Jan to Dec 2014) was conducted of occupational therapy sessions within a specialist HIV rehabilitation unit. Basic and instrumental activities of daily living were included, situated within the unit and local community | ||||
| Results / Comments: Data was available on 28 individuals. All were taking HAART at the time of intervention. Age in years ranged from 23 to 69, with a mean of 50, and a median of 53. Twenty men and 8 women living with HIV formed the cohort reviewed. With regard to ethnicity individuals had the following backgrounds Black African (16), White United Kingdom / European (10), Pakistan (1), and Afro-Caribbean (1). A diagnosis of HIV encephalopathy was the most common (13), followed in frequency by other diagnosis (8), progressive multifocal leucoencephalopathy (4) and cerebral toxoplasmosis (3). Results were stratified by CD4 and viral load <200 and >201. CD4 results were unavailable for one individual, and viral load results were unavailable for two individuals. Fifteen individuals had a CD4 <200, eleven had a CD4 >201, seven individuals had a viral load <200 and eighteen had a viral load of >201. The percentage of sessions offered that were declined ranged from 0 to 55.6%. The mean was 31.27%, and the median 44.8%. In rank order by frequency reasons for declining sessions were ‘not interested’ (13), ‘asleep’ (9), ‘unwell’ – non-HIV (8), fatigued (8) unwell- HIV (7) related, ‘pain’ (7), ‘engaged in other unplanned activity’ (7), ‘no reason’ (2), ‘not available’ (2). | ||||
| Discussion: In a clinical setting with diverse needs, this model may assist professionals to recognise potential challenges episodic disability presents. Reasons for unavailability of individuals in this cohort for sessions may reflect features of • Underlying diagnoses • Episodic disability • Cognitive impairment • Psychological health • Psychosocial stressors • Other co-morbidities Admissions to the unit are expected to be acutely medically stable. However, this data indicates that health and functional performance variability remains. This can impede the processes of assessment and rehabilitation. A flexible, individualised approach is required to recognise and accommodate such fluctuations when they occur. Although the numbers reviewed were small, and referral bias cannot be excluded, it is possible to extrapolate from these findings. Many HIV+ individuals will be accessing services providing interventions to people living with a range of diagnoses. The experience outlined may inform service delivery where episodic disability may form part of the clinical picture | ||||
| Go Back | ||||