Abstract
Research question/objective: The objectives of this scoping review are to describe the physical impairments and subsequent level of function of adult individuals infected with the human immunodeficiency virus (HIV) admitted to an acute care hospital, determine the outcome measures used by rehabilitation professionals when evaluating said impairments and level of function in the population of interest, and identify the rehabilitation interventions offered to individuals while in hospital as a means of addressing these physical impairments and individuals' functional status.
Specifically, the research questions are:
* What are the physical impairments experienced by adult individuals infected with HIV admitted to hospital and their subsequent level of function?
* Which outcome measures are used by rehabilitation professionals when evaluating physical impairments and level of function of adult individuals infected with HIV when in hospital?
* What rehabilitation interventions are offered when addressing physical impairments and functional status of adult individuals infected with HIV when in hospital?
The current scoping review will comprehensively identify the physical impairments of people living with HIV when admitted to an acute care hospital and highlight the subsequent influence on their level of function as a means of emphasizing the disability present. Findings regarding the rehabilitation interventions offered could inform clinical practice as a means of mapping which interventions are offered to address the related physical impairments and thus highlight areas for future research.
Article Content
Background
The human immunodeficiency virus (HIV) is a global health concern as it has claimed 34 million lives thus far and in 2014 36.9 million people were living with HIV.1 Sub-Saharan Africa remains the region most affected by this disease as 25.8 million people were living with HIV in 2014.1 However, people living with HIV (PLWH) are living longer due to effective disease management with increased access to care and antiretroviral therapy.2,3 The life expectancy of PLWH reported may vary in the literature in light of the difference in prevalence of the disease and healthcare services available in the respective countries of populations studied. The life expectancy difference between PLWH and non-infected individuals is reported to be eight years in the United States of America.2 In a high HIV prevalence country such as South Africa, the life expectancy of PLWH is reported to be between 70% and 86%, similar to non-infected individuals of the same age and gender.3 This disease is therefore now considered a chronic illness where individuals might fluctuate between episodes of illness, wellness and disability.4
Even though the life expectancy of PLWH has increased, the reported hospitalization rates of PLWH vary. A reduction in hospitalization rates was reported in a Danish cohort during 1995-2007 compared to a large American cohort where hospitalization rates stayed constant during 1999-2007.5,6 The two leading causes of hospital admissions in adult patients worldwide are reported to be bacterial infections and AIDS-related illnesses.7 Medical conditions treated during hospital admission frequently include respiratory conditions, for example, Pneumocystis jirovecii pneumonia; neurological manifestations, for example, cerebrovascular accidents or meningitis and septicemia; and others.7-9 Following hospital admission, PLWH with severe immunosuppression, advanced age or comorbidities may require intensive care unit (ICU) management.10 Factors reported to reduce PLWH's ability to survive ICU include lower CD4 counts,11,12 the need for mechanical ventilation,13 presence of a tuberculosis diagnosis,13,14 higher acute physiology and chronic health evaluation scores11,13 and lower functional status prior to ICU admission.15
Functional status is defined as an individual's ability to perform activities of daily living such as rolling in bed, transferring into a chair and walking.16 Individuals' functional status can be influenced by their physical impairments that are influenced by any body structure and function alterations.16 A number of factors have been identified in PLWH that could alter or influence their body structure and function. It is known that skeletal muscle dysfunction varies in PLWH, depending on their immunological status and antiretroviral therapy used.17 Anemia and a reduction in pulmonary diffusion capacity have also been reported to develop in PLWH that may contribute to individuals experiencing fatigue and shortness of breath.18,19 In addition, the risk of chronic obstructed pulmonary disease and coronary artery disease is increased in PLWH and independently associated with HIV.20,21 A reduction in exercise capacity in healthy PLWH are related to lower peak oxygen utilization and reduced respiratory muscle strength.22,23 In some instances, antiretroviral therapy may have negative side effects on individuals' mobility. Stavudine-containing regimens are known to increase the risk of distal sensory polyneuropathy, and this additional condition could influence individuals' balance and subsequent walking ability.24 Moderate-to-severe pain is often experienced by PLWH, and the type of pain ranges from headaches, joint and muscle pain to pain due to polyneuropathy.25,26 The etiology of pain in PLWH is said to vary from direct effects of HIV to immune suppression and presence of opportunistic infections to possible side effects of antiretroviral therapy.26 These factors may therefore influence PLWH's functional status and physical impairments experienced to varying degrees.
The implementation of rehabilitation programs by healthcare practitioners is beneficial in improving the functional ability of PLWH. Systematic reviews are available that assess the effects of rehabilitation programs in PLWH.27-29 The reviews however focus on PLWH in the community when individuals are relatively healthy, and less is known regarding the rehabilitation of PLWH when admitted to an acute care hospital. Functional statuses of PLWH admitted to an acute care setting are reported to be reduced as individuals are noted to require assistance when performing bed mobility, transfers and walking.9,15,30 The functional status of PLWH who have survived an ICU stay could range from individuals requiring considerable assistance to some individuals being able to perform activities of daily living with minor signs and symptoms of the disease.15 Physical impairments reported in PLWH admitted to an acute care setting include decreased muscle strength, decreased exercise capacity, pain, changes in sensation, fatigue and breathing problems such as breathlessness.9,30 Even though PLWH when admitted to hospital often present with physical impairments and reduced functional status, referrals of patients to rehabilitation professionals during their hospital stay vary. Referrals can range from 2% to 60% of patients.31,32 Factors predicting referrals are noted to be prolonged length of stay in hospital (more than eight days) and reduced functional status in bed mobility, transfers and ambulation at the time of admission to hospital.9
Key research priorities have been identified in the field of HIV and rehabilitation in which identifying the physical impairments and functional status of PLWH is stated to be vital in establishing the level of disability present in this population.33 In addition, investigating the rehabilitation services offered and the effects of such services to PLWH is another research priority that has been noted.33 This scoping review will thus contribute to the wider body of knowledge related to HIV, disability and rehabilitation by collating information regarding the topic of interest but focusing on PLWH admitted to an acute care hospital. A search of published literature in PubMed and Cochrane database was undertaken to identify whether scoping or systematic reviews are currently available regarding the topic of interest - none were found. A scoping review will be conducted that will follow the JBI Scoping Review methodology.34,35 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and flow diagram will be used in the presentation of the results of the scoping review.36
Inclusion criteria
Types of participants
The current review will consider studies that include adult patients (18 years and older; male and female) with HIV infection (receiving or antiretroviral therapy-naive) in an acute care hospital setting.
Concept
The current review will consider studies that report on the functional status and physical impairments experienced by adult patients infected with HIV admitted to an acute care hospital.
The topics for inclusion will be but are not limited to:
* Functional status determined by a healthcare practitioner.
* Physical impairments reported by patients.
* Physical impairments established by a healthcare practitioner.
* Interventions provided by healthcare practitioners working in the rehabilitation field, for example, physiotherapists, or occupational therapists or speech therapists.
Context
The context for this scoping review is the acute care setting. Studies will be included if they provide information regarding the concept of interest and if study participants are cared for in a hospital ward or high care unit or ICU.
Types of sources
The scoping review will consider quantitative and qualitative studies of any design and methodology.
Quantitative studies may include, but not be limited to, experimental and observational study designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, pre- and post-test designs, cohort studies, case-control studies and cross-sectional studies. Qualitative studies may include, but not be limited to, designs such as phenomenology, grounded theory and ethnography.
Search strategy
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE using PubMed and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Third, the reference list of all identified articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. Studies published from 1982 (when the term acquired immune deficiency syndrome was first reported by the Centre for Disease Control and Prevention) will be considered for inclusion in this review.
The databases to be searched include:
* MEDLINE using PubMed
* PsycINFO
* Scopus
* Pedro
* Embase
* CENTRAL
* CINAHL Plus
The search for unpublished studies will include a review of gray literature in Google Scholar; online publications of research reports, dissertations and thesis at ProQuest; online publications available at mobilization-network.org; and publications from relevant organizations such as World Health Organization and United Nations Program on HIV/AIDS.
Initial keywords to be used will be HIV; hospital; acute care; ICU; function; functional status; functional outcome; activities of daily living; mobility; physical activity; impairment; dysfunction; muscle strength; joint range of motion, exercise capacity; exercise tolerance; pain; breathlessness; fatigue; sensation; proprioception; balance; rehabilitation.
Two reviewers will assess whether sourced articles align with the inclusion criteria of the review. If disagreement exists between these two reviewers, then a third reviewer will be consulted with regard to the inclusion of the specific study.
Data mapping
A charting form (Appendix I) will be used to record characteristics of the included studies and the information relevant to the review questions. The charting form will be refined during the first two studies reviewed to ensure that the relevant results are extracted. Two reviewers will independently extract data from the first five studies onto the data capture table. They will then meet to determine if their method of data extraction is consistent with the research questions. Thereafter, the reviewers will extract data independently. Any disagreement will be discussed with and resolved by a third reviewer. Authors of primary studies will be contacted for clarification or missing information if the need arises.
Data synthesis
The number of studies found, included and excluded will be shown in a PRISMA flow diagram.33 The results will be outlined in table and descriptive formats to align with the research questions of the scoping review, according to conceptual categories identified during extraction of the results. In the event that an intervention has included a comparative group, findings will be presented to clearly outline study findings.
Appendix I: Data capture form
References
1. World Health Organization. HIV/AIDS [Internet]. 2016. Available from: http://www.who.int/mediacentre/factsheets/fs360/en/. [Accessed May 24, 2016]. [Context Link]
2. Marcus JL, Chao CR, Leyden WA, Xu L, Quesenberry CP Jr, Klein DB, et al. Narrowing the gap in life-expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr 2016; 73 1:39-46. [Context Link]
3. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African Adults starting antiretroviral treatment: collaboration analysis of cohort studies. PLoS Med 2013; 10 4:e1001418. [Context Link]
4. Nixon SA, Hanass-Hancock J, Whiteside A, Barnett T. The increasing chronicity of HIV in sub-Saharan Africa: re-thinking "HIV as a long-wave event" in the era of widespread access to ART. Global Health 2011; 7 41:1-5. [Context Link]
5. Engsig FN, Hansen AE, Gerstof J, Kronborg G, Larsen CS, Oberl N. Inpatient admissions and outpatient visits in persons with and without HIV infection in Denmark, 1995-2007. AIDS 2010; 24 3:457-461. [Context Link]
6. Crum-Cianflone NF, Grandits G, Echols S, Ganesan A, Landrum M, Wientrob A, et al. Trends and causes of hospitalizations among HIV-infected persons during the late HAART era: What is the impact of CD4 counts and HAART use? J Acquir Immune Defic Syndr 2010; 54 3:248-257. [Context Link]
7. Ford N, Shubber Z, Meintjes G, Grinsztejn B, Eholie S, Mills EJ, et al. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV 2015; 2 10:e438-e444. [Context Link]
8. Patil VC, Patil HV. Clinical manifestations and outcomes of patients with human immunodefiency virus infection at tertiary care teaching hospital. Indian J Sex Transm Dis 2016; 37 1:38-45. [Context Link]
9. Kinirons SA, Do S. The acute care physical therapy HIV/AIDS patient population: a descriptive study. J Int Assoc Provid AIDS Care 2015; 14 1:53-63. [Context Link]
10. Barbier F, Roux A, Canet E, Martel-Samb P, Aegerter P, Wolff M, et al. Temporal trends in critical events complicating HIV infection: 1999-2010 multicentre cohort study in France. Intensive Care Med 2014; 40 12:1906-1915. [Context Link]
11. Foo H, Clezy K, Post JJ. The long-term outcome of HIV-infected patients after intensive care admission. Int J STD AIDS 2012; 23 6:e4-e8. [Context Link]
12. Pathak V, Rendon IS, Atrash S, Gagadam VP, Bhunia K, Mallampalli SP, et al. Comparing outcomes of HIV versus non-HIV patients requiring mechanical ventilation. Clin Med Res 2012; 10 2:57-64. [Context Link]
13. Amancio FF, Lambertucci JR, Cota GF, Antunes CM. Predictors of the short- and long-term survival of HIV-infected patients admitted to a Brazilian intensive care unit. Int J STD AIDS 2012; 23 10:692-697. [Context Link]
14. Balkema CA, Irusen EM, Taljaard JJ, Koegelenberg CFN. Tuberculosis in the intensive care unit: a prospective observational study. Int J Tuberc Lung Dis 2014; 18 7:824-830. [Context Link]
15. Casalino E, Mendoxa-Sassi G, Wolff M, Bedos FP, Gaudebout C, Regnier B, et al. Predictors of short- and long-term survival in HIV-infected patients admitted to the ICU. Chest 1998; 113 2:421-429. [Context Link]
16. American Thoracic Society. Functional status [Internet]. Available from: http://qol.thoracic.org/sections/key-concepts/functional-status.html. [Accessed May 24, 2016]. [Context Link]
17. Authier FJ, Chariot P, Gherardi RK. Skeletal muscle involvement in human immunodeficiency virus (HIV)-infected patients in the era of highly active antiretroviral therapy (HAART). Muscle Nerve 2005; 32 3:247-260. [Context Link]
18. Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of anemia in human immunodefiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 1998; 1 1:301-308. [Context Link]
19. Calligaro GL, Gray DM. Lung function abnormalities in HIV-infected adults and children. Respirology 2015; 20 1:24-32. [Context Link]
20. Morris A, George MP, Crothers K, Huang L, Lucht L, Kessinger C, et al. HIV and chronic obstructive pulmonary disease: is it worse and why? Proc Am Thorac Soc 2011; 8 3:320-325. [Context Link]
21. Triant VA, Meigs JB, Grinspoon SK. Association of C-reactive protein and HIV infection with acute myocardial infarction. J Acquir Immune Defic Syndr 2009; 51 3:268-273. [Context Link]
22. Jeronimo FS, Alves GN, Cipriano G, Vieira PJC, Chiappa AMG, Chiappa GR. Factors associated with inspiratory muscle weakness in patients with HIV-1. Braz J Infect Dis 2015; 19 1:1-7. [Context Link]
23. Beans J, Stevenson T, Katzel LI, Sorkin JD, Warner AL, Gottlieb SS, et al. Ambulatory function in men with and without HIV infection: association with cardiorespiratory fitness. J AIDS Clinic Res 2013; S9:003. [Context Link]
24. Shurie JS, Deribew A. Assessment of the prevalence of distal symmetrical polyneuropathy and its risk factors among HAART-treated and untreated HIV infected individuals. Ethiop Med J 2010; 48 2:85-93. [Context Link]
25. Hewitt DJ, McDonald M, Portenoy RK, Rosenfeld B, Passik S, Breitbart W. Pain syndromes and etiologies in ambulatory AIDS patients. Pain 1997; 70 (2-3):117-123. [Context Link]
26. Parker R, Stein DJ, Jelsma J. Pain in people living with HIV/AIDS: a systematic review. J Int AIDS Soc 2014; 17 1:18719. [Context Link]
27. Stevens ME, Nixon SA. Research on rehabilitation interventions for adults living with HIV: a scoping review. Int J Rehabil Res 2016; 39 2:106-116. [Context Link]
28. O'Brien KK, Tynan AM, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis 2016; 16:182. [Context Link]
29. Cobbing S, Hanass-Hancock J, Myezwa H. Home-based rehabilitation interventions for adults living with HIV: a scoping review. Afr J AIDS Res 2016; 15 1:77-88. [Context Link]
30. Myezwa H, Stewart A, Musenge E, Nesara P. Assessment of HIV-positive in-patients using the International Classification of Functioning, Disability and Health (ICF) at Chris Hani Baragwaneth Hospital, Johannesburg. Afr J Aids Res 2009; 8 1:93-105. [Context Link]
31. Myezwa H, Stewart A, Mbambo N, Nesara P. Status of referral to physiotherapy among HIV positive patients at Chris Hani Baragwaneth Hospital Johannesburg South Africa 2005. SAJP 2007; 63 2:27-31. [Context Link]
32. Maharaj SS, Rangiah P. The prevalence of co-morbidities in patients on HAART referred for physiotherapy in three public hospitals in Kwa Zulu Natal, South Africa: a short report. SAJP 2010; 66 3:21-24. [Context Link]
33. O'Brien K, Wilkins A, Zack E, Solomon P. Scoping the field: Identifying key research priorities in HIV and rehabilitation. AIDS Behav 2010; 14 2:448-458. [Context Link]
34. Peters M, Godfrey C, McInerney P, Baldini SC, Khalil H, Parker D. Aromataris E. Methodology for JBI scoping reviews. The Joanna Briggs Institute, The Joanna Briggs Institute reviewers' manual 2015. Adelaide, Australia:2015. [Context Link]
35. Peters MDJ, Godfrey CM, Khalili H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13 3:141-146. [Context Link]
36. Moher D, Liberati A, Tetzlaff J, Altman TG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 7:e1000097. [Context Link]