Sie sind auf Seite 1von 8

This article was downloaded by: [Zahir] On: 1 September 2009 Access details: Access Details: [subscription number

903106798] Publisher Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

AIDS Care
Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713403300

Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS
Abhay M. Gaidhane a; Quazi Syed Zahiruddin a; Lalit Waghmare b; Sanjay Zodpey c; R. C. Goyal a; S. R. Johrapurkar d a Department of Community Medicine, DMIMS, Wardha, Maharashtra, India b Department of Physiology, DMIMS, Wardha, Maharashtra, India c Department of Community Medicine, VNGMC, Yaratmal, Maharashtra, India d Director, DMDPGMER, DMIMSU, Wardha, India First Published:October2008

To cite this Article Gaidhane, Abhay M., Zahiruddin, Quazi Syed, Waghmare, Lalit, Zodpey, Sanjay, Goyal, R. C. and Johrapurkar, S.

R.(2008)'Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS',AIDS Care,20:9,1098 1104
To link to this Article: DOI: 10.1080/09540120701808820 URL: http://dx.doi.org/10.1080/09540120701808820

PLEASE SCROLL DOWN FOR ARTICLE


Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

AIDS Care Vol. 20, No. 9, October 2008, 10981104

Assessing self-care component of activities and participation domain of the international classication of functioning, disability and health (ICF) among people living with HIV/AIDS
Abhay M Gaidhanea, Quazi Syed Zahiruddina*, Lalit Waghmareb, Sanjay Zodpeyc, R.C. Goyala, and S.R. Johrapurkard
a Department of Community Medicine, DMIMSU, Wardha, Maharashtra, India; bDepartment of Physiology, DMIMSU, Wardha, Maharashtra, India; cDepartment of Community Medicine, VNGMC, Yaratmal, Maharashtra, India; dDirector, DMDPGMER, DMIMSU, Wardha, India

(Received 17 July 2007; final version received 13 November 2007) Disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities. This study aimed to find out the nature of self-care among people living with HIV/AIDS (PLWHA) in rural tertiary care center. The objectives were to determine reported self-care by performance qualifier of PLWHA and to find out reported self-care by capacity qualifier of PLHIV. A cross sectional study was conducted among the 194 PLHIV in rural tertiary care hospital. The Self-Care (d5) component of Activities and Participation domain (d) of the International Classification of Functioning, Disability and Health (ICF) was used. Among the 194 PLHIV patients studied, 82% were male. The average age was 36.87 years (SD99.01) with a median of 35 years, varying from 15 to 65 years. Over 65% of the study group experienced one or more impairments. As HIV disease has become a more lifelong, unpredictable, but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns.

Downloaded By: [Zahir] At: 10:29 1 September 2009

Keywords: self-care; ICF; people living with HIV/AIDS; performance qualier

Introduction At one time, HIV disease was a progressive, deteriorating and terminal illness with no effective treatment and caused an often-rapid decline in health, leading to death. The management of HIV-infected patients has undergone dramatic change during the past several years with the advent of antiretroviral therapy (Libman & Stein, 2003). Over the decades, the global campaign against HIV/AIDS has focused not only on decreasing the spread of the disease, but also on promoting and improving the health and quality of life of the people living with HIV/AIDS (PLWHA) world-wide (Hwang, Jeng-Liang; Nochajski, & Susan, 2003). Treatment has lead to improved health, however, with this encouraging news have come the important challenges of attending to daily tasks of self-care and participating in physical activities (Vosvick et al., 2003) and increased life expectancy for many people (Zonta & Almeda, 2005). So, also, with an alarming increase of HIV/AIDS in developing countries and inability to afford highly active antiretroviral therapy, key issues like the quality of life have come to the fore (Wig et al., 2006). The disability experience of persons with HIV illness has shifted from issues related to physical well*Corresponding author. Email: zahirquazi@rediffmail.com
ISSN 0954-0121 print/ISSN 1360-0451 online # 2008 Taylor & Francis DOI: 10.1080/09540120701808820 http://www.informaworld.com

being to those concerning performance of daily life activities and wider community participation (Anandan, Braveman, Kielhofner, & Forsyth, 2006). Living longer with HIV often means dealing with impairments, activity limitations and participation restrictions that range from moderate or inconvenient to severe and debilitating, which is one of the more important determinants of health-related quality of life in PLWHA (Rusch et al., 2004) Based on the International Classification of Function, Disability and Health (ICF) framework, the following study provides a systematic outlook of the HIV/AIDS related self-care. It also determines the magnitude of self-care disablement of PLWHA by performance qualifier and by capacity qualifier related to: washing; caring for body parts; toileting; dressing; eating; drinking; and looking after ones health. When used in the relevant fields (e.g. chronic healthcare, rehabilitation, epidemic, disability research, policy making), the ICF framework and its coding scheme provide a systematic view of the processes involved in the consequences of a health condition (e.g. disease, disorder, injury, trauma) and a classification of the individuals disablement within the context of his or her personal life situations and

AIDS Care environments (Hwang et al. 2003). Several rehabilitation facilities have used the ICF; their experiences are encouraging and provide a common vocabulary for both people with disability and for professionals in the fields of rehabilitation and disability (Schuntermann, 2005). However, limited information is available on the specific impairments of self-care prevalent in the emergent population of PLWHA and on the impact of the impairments of self-care issues of washing, caring for body parts, toileting, dressing, eating, drinking and looking after ones health on the persons functional performance and participation in various occupations of daily living. There are very few published studies in regard to disabilities of people living with HIV/AIDS in developing countries and India as per ICF. The present study attempted to explore the selfcare issues as the emergent population of PLWHA experiences them. This study will benefit all those healthcare providers working in primary healthcare, agencies working on home-based programs and caregivers. It will promote, restore and maximize a persons level of comfort and function, which includes care towards a dignified death. Methods This cross-sectional study was conducted among the PLWHA who came to this 850-bed tertiary care teaching hospital, Wardha of Datta Meghe Institute Of Medical Sciences University (NAAC Accredited Grade A), between 1st February 2006 and 30th March 2007. Patients visit this hospital from various states, mostly from central India. Out of 237 participants who came, 194 were included in the study. Twenty participants who were not willing to participate, and others who withdrew in between (23), were excluded from the analysis. Thus the response rate was 81.85%. This study was conducted with approval from the Institutional Ethical Committee. Each patient was examined once. Individuals at all stages of HIV infection were included. All 194 patients had proven HIV infection and all had met the WHO stage criteria for the diagnosis of AIDS. Participants were evaluated according to pre-designed protocol. People with HIV/AIDS were explained the purpose of the study and were requested to participate. Those who consented to participate had a chance of being included. Others, who left the interview and examination halfway for various reasons, were excluded from the study. Rapport was developed with the participants and data was collected using a structured interview schedule and examination by trained and experienced evaluators. Each interview and examination lasted for

1099

at least 4560 minutes. At the end of the interview and examination the questionnaire was checked for completeness and the interviewer thanked the responder. The domain of Self-Care (d5) was studied from the component Activity and Participation of the International Classification of Functioning, Disability and Health (ICF) considering all categories from the perspectives of activities and participation. The component of Activity and Participation refers to an individuals performance of tasks or accomplishments, either physical or mental, which are associated with all aspects of human life (e.g. learning and applying knowledge, communication, mobility, self-care). This component involves the integrated use of body functions in a purposeful manner within various contexts, including physical, social and attitudinal environments (World Health Organization, 2001). In this study, we focused on a single ICF domain of Self-Care that contains nine coded construct coding scheme. The domain of Self-Care describes basic activities of daily living (ADLs), such as washing, caring for body parts, toileting, dressing, eating, drinking and looking after ones health. The full (detailed) version extended to four levels and qualified by the two qualifiers of Performance (1st qualifier) and Capacity (2nd qualifier) using generic scale represented through a 04 point scale (xxx.0 0no problem, xxx.1 0mild problem, xxx.2 0 moderate problem, xxx.3 0severe problem, xxx.4 0 complete problem; where xxx symbolizes the first two levels of coding). In addition, the use of both Performance (1st qualifier) and Capacity (2nd qualifier) with these codes would serve to specify the clients capability of carrying out the ADLs under different given situations. The gap between performance and capacity reflects the difference between the impacts of current and uniform environments and, thus, provides a useful guide as to what can be done to the environment of the individual to improve performance (WHO, 2001). The ICF-systematic coding scheme, was used as it has following advantages: . Uniform terminology. . Can serve to enhance communications between healthcare professionals and people with disabilities. . Improves the comparability of data across countries, sectors, disciplines, services and time. . [jnmc1]Is aIIIs a useful tool for identifying the nature and magnitude of health and social issues for PLWHA and different dimensions of disabilities of PLWHA.

Downloaded By: [Zahir] At: 10:29 1 September 2009

1100

A.M Gaidhane et al. Eating and drinking. By Performance qualifier in his or her current environment, 16% of the participants faced mild to complete problem in eating, 26.3% of the participants had problems while drinking. When measured by Capacity qualifier, 27.3 and 37.1%, of the participants faced problems with urination and defaecation, respectively, in the standardized environment. Looking after ones health. By Performance qualifier in his or her current environment, 44.8% of the participants faced mild to complete problem in maintaining their health. While 38.7 and 37.6% of the participants had problems while caring for themself and managing diet/fitness, respectively. When measured by Capacity qualifier, 65.5, 63.9 and 58.8% of the participants faced problems while caring for themself and managing diet/fitness, respectively, in the standardized environment. Discussion While impaired ability to perform self-care tasks is the major determinant of need for formal or informal personal care services or other long-term care, relatively little work has been done on the extent of self-care impairment in these tasks. Understanding these patterns, however, is important in planning services for persons with HIV disease. This study provides a systematic view of the Activity and Participation Self Care of PLWHA. In our study we have observed that a hospital-based sample of people living with HIV in rural tertiary care center have been experiencing strikingly high levels of activity limitations and participation restrictions of self-care by ICF. No published data was available where use of the full (detailed) version extended to four levels and qualified by the two qualifiers (Performance [1st qualifier] and Capacity [2nd qualifier]) was used by means of a generic 04 point scale. In our study, the use of both Performance (1st qualifier) and Capacity (2nd qualifier) served to specify the clients capability of carrying out the activities under different given situations. In this study, around 65% of the study group experienced one or more impairment, while in the study conducted in Brazil by Zonta et al. (2003), 91% of the patients had some degree of functional impairment. When measured by Capacity qualifier, around 30% of the participants in our study faced problems while bathing a body part or the whole body or drying themselves in the standardized environment, whereas by Performance qualifier in his or her current environment, it was only around 15%, which

It fulfils the requirement of a very useful, reliable and valid multidimensional framework for defining domains and describing chronic disability (World Health Association, 2002). Therefore, the ICF needs to be applied to various health conditions/diseases in order to document its practical usefulness. Quality assurance measures were taken appropriately. Anonymity was maintained throughout data processing and analysis. Categories in which most participants were coded with qualifier 9 (not applicable) or Qualifier 8, 9 (not specified) were excluded. Results Among the 194 participants, 103 (53.09%) were unemployed and 91 (46.90%) had quit their jobs for infection-related reasons. Average time since notification of HIV status was approximately two years. Among the 194 participants studied, 82% were male and the average age was 36.8799.01 years. In the Self-Care domain (d5), 64% participants reported problems measured as 14-point (mild to complete problem) scale by the Performance qualifier, which describes what an individual participant does in his or her current environment. Washing oneself. By Performance qualifier in his or her current environment, only 17% of the participants faced a mild to complete problem in drying oneself. While 10.8 and 13.4% of the participants had problems while washing whole body or body parts, respectively. When measured by Capacity qualifier, 29.4, 30.4 and 28.9% of the participants faced problems while drying oneself, washing the whole body or while washing body parts in the standardized environment. Caring for body parts. By Performance qualifier in his or her current environment, 29.4% of the participants faced mild to complete problem in caring for toenails. While 23.2, 18.6, 17, and 14.9% of the participants had problems while caring for fingernails, hair, teeth and skin, respectively. When measured by Capacity qualifier, 47.9, 42.8, 36.6 and 28.9% of the participants faced problems while caring for toenails, fingernails, hair, teeth and skin, respectively, in the standardized environment. Toileting. By Performance qualifier in his or her current environment, 25.6% of the participants faced mild to complete problem in urinating. While 45.4% of the participants had problems while defaecation with 4.6% had a complete problem. When measured by Capacity qualifier, 44.3 and 63.9% of the participants faced problems with urination and defaecation, respectively, in the standardized environment.

Downloaded By: [Zahir] At: 10:29 1 September 2009

AIDS Care
Table 1. Showing the functional ability of Performance qualier. Performance qualifier of PLWHA No problem (0) n (%) Mild problem (1) n (%) Moderate problem (2) n (%) Severe problem (3) n (%)

1101

Self-care (d5) Washing oneself (d510) Washing body part (d5100) Washing whole body (d5101) Dry oneself (d5102) Caring for body parts (d520) Caring for skin (d5200) Caring for teeth (d5201) Caring for hair (d5202) Caring for fingernails (d5203) Caring for toenails (d5204) Toileting (d530) Regulating urination (d5300) Regulating defaecation (d5301)
Downloaded By: [Zahir] At: 10:29 1 September 2009

Complete problem (4) n (%)

168 (86.6) 173 (89.2) 161 (83.0) 165 161 158 149 137 (85.1) (83.0) (81.4) (76.8) (70.6)

14 (7.2) 11 (5.7) 19 (9.8) 15 18 19 25 29 (7.7) (9.3) (9.8) (12.9) (14.9)

6 (3.1) 5 (2.6) 6 (3.1) 6 7 9 16 15 (3.1) (3.6) (4.6) (8.2) (7.7)

4 (2.1) 3 (1.5) 5 (2.6) 5 6 7 3 9 (2.6) (3.1) (3.6) (1.5) (4.6)

2 (1.0) 2 (1.0) 3 (1.5) 3 2 1 1 4 (1.5) (1.0) (0.5) (0.5) (2.1)

145 (74.4) 106 (54.6) 113 109 139 144 171 163 143 (58.6) (56.2) (71.6) (74.2) (88.1) (84.0) (73.7)

31 (16.4) 49 (25.5) 42 44 29 22 11 15 24 (21.6) (22.7) (14.9) (11.3) (5.7) (7.7) (12.4)

12 (6.2) 15 (7.7) 28 24 14 19 6 9 16 (14.4) (12.4) (7.2) (9.8) (3.1) (4.6) (8.2)

4 (2.0) 13 (6.7) 8 12 9 6 4 5 10 (4.1) (6.2) (4.6) (3.1) (2.1) (2.6) (5.2)

2 (1.0) 9 (4.6) 3 5 3 3 2 2 1 (1.5) (2.6) (1.5) (1.5) (1.0) (1.0) (0.5)

Dressing (d540) Putting on clothes (d5400) Taking off clothes (d5401) Putting on footwear (d5402) Taking off footwear (d5403) Choosing appropriate clothing (d5404) Eating (d550) Drinking (d560) Looking after ones health (d570) Ones physical comfort (d5700) Managing diet and fitness (d5701) Maintaining ones health (d5702)

121 (62.4) 119 (61.3) 107 (55.2)

53 (27.3) 57 (29.4) 51 (26.3)

11 (5.7) 10 (5.2) 19 (9.8)

6 (3.1) 5 (2.6) 11 (5.7)

3 (1.5) 3 (1.5) 6 (3.1)

is slightly more than in the study of Zonta, Almeida, Carvalho & Werneck, 2005, in which 24% had problem while bathing. Similarly, only 17% had problem while washing in the study conducted by Mumba (2005). Around 28% of the participants in our study, had problems while eating in the standardized environment when measured by Capacity qualifier. Whereas by Performance qualifier in his or her current environment it was only around 16%, which is slightly less than in the study of Rusch et al. (2004), in which 20% had problems while eating. In the standardized environment, when measured by Capacity qualifier, around 45% had problems while urinating. By Performance qualifier in his or her current environment, it was only around 25%, which is slightly more than in the study of Marise et al. (2005), in which 19% had problems while urinating. In our study it was observed that around 64% had problems while defaecating in the standardized environment when measured by Capacity qualifier.

Whereas, when measured by Performance qualifier in his or her current environment, it was around 45%, which is more than in the study of Marise et al. (2005), in which 15% had problems while defaecating and in the study conducted by Mumba (2005), in which 11% had problems while toileting. In the study conducted by Mumba (2005), around 9% had problems while dressing. This finding was also seen in the study by Rusch et al. (2004), in which the prevalence of 8.9% social restricting was seen for getting dressed. While in our study, by Performance qualifier in his or her current environment, the maximum number of participants (57%) had problems while taking off and putting on clothes, only around 12% of participants faced difficulties while choosing appropriate clothing. Our study reveals that people living with HIV have been experiencing high rates of impairments, activity limitations and participation restrictions in self-care, particularly in maintaining their health and while defaecating. The impairment in washing and

1102

A.M Gaidhane et al.

Table 2. Showing the functional ability of Capacity qualier. Capacity Qualifier of PLHAs No problem (0) n (%) Mild problem (1) n (%) Moderate problem (2) n (%) Severe problem (3) n (%) Complete problem (4) n (%)

Self-Care (d5) Washing oneself (d510) Washing body part (d5100) Washing whole body (d5101) Dry oneself (d5102) Caring for body parts (d520) Caring for skin (d5200) Caring for teeth (d5201) Caring for hair (d5202) Caring for fingernails (d5203) Caring for toenails (d5204) Toileting (d530) Regulating urination (d5300) Regulating defaecation (d5301)
Downloaded By: [Zahir] At: 10:29 1 September 2009

138 (71.1) 135 (69.6) 137 (70.6) 138 129 123 111 101 (71.1) (66.5) (63.4) (57.2) (52.1)

24 (12.4) 21 (10.8) 25 (12.9) 31 34 37 43 45 (16) (17.5) (19.1) (22.2) (23.2)

17 (8.8) 19 (9.8) 15 (7.7) 18 16 18 21 26 (9.3) (8.2) (9.3) (10.8) (13.4)

11 (5.7) 12 (6.2) 14 (7.2) 5 (2.6) 10 (5.2) 12 (6.2) 11 (5.7) 17 (8.8) 11 (5.7) 21 (10.8) 20 (10.3) 24 (12.4) 17 (8.8) 21 (10.8) 7 (3.6) 11 (5.7) 13 (6.7) 15 (7.7) 21 (10.8) 22 (11.3)

4 (2.1) 7 (3.6) 3 (1.5) 2 5 4 8 5 (1.0) (2.6) (2.1) (4.1) (2.6)

108 (55.7) 70 (36.1) 95 (49.0) 80 (41.2) 97 (50.0) 101 (52.1) 164 (84.5) 141 (72.7) 122 (62.9) 78 (40.2) 70 (36.1) 67 (34.5)

51 (26.3) 62 (32.0) 43 45 47 42 11 24 30 (22.2) (23.2) (27.2) (21.6) (5.7) (12.4) (15.5)

18 (9.3) 32 (16.5) 28 33 28 27 10 14 22 (14.4) (17) (14.4) (13.9) (5.2) (7.2) (11.3)

6 (3.1) 11 (5.6) 8 (4.1) 12 (6.2) 5 (2.6) 3 (1.5) 2 (1.0) 4 (2.1) 7 (3.6) 12 (6.2) 9 (4.6) 17 (8.8)

Dressing (d540) Putting on clothes (d5400) Taking off clothes (d5401) Putting on footwear (d5402) Taking off footwear (d5403) Choosing appropriate clothing (d5404) Eating (d550) Drinking (d560) Looking after ones health (d570) Ones physical comfort (d5700) Managing diet and fitness (d5701) Maintaining ones health (d5702)

61 (31.4) 62 (32) 57 (29.4)

28 (14.4) 32 (16.5) 31 (16.0)

caring for body parts was not noteworthy. Hwang et al. (2003) has stated that impairments in physical (or possibly cognitive) functions due to neurological deconditioning constitutes the greatest limitation to individuals mobility and ability to perform activities of daily living. Furthermore, the complex interrelationships identified amongst the levels reveal lessons for programming, policy and research in terms of the factors that contribute most to a higher quality of life. The core set of functions might serve as a functional review of systems and routine screen for frailty (Hebert & Veil, 2004). Results demonstrate the need for flexible and responsive systems for authorizing and managing inhome services for people with HIV disease, systems that can respond to frequent changes in the functional status and level-of-care needs of these individuals. They suggest further attention to special care needs that may be experienced by people with HIV disease.

Physicians typically overlook the disabilities perceived by their patients. Program evaluators and clinicians in integrated settings have long struggled with applicability of normative data across populations. It is hoped that the use of the ICF will lead to more effective communication of information about health outcomes of PLHIV across a wide range of cultural and healthcare settings. Consequently, the strategies for identifying healthcare needs, tailoring intervention programs and establishing related policies for PLHIV will be further developed around the world. The routine collection of these core functions during patient encounters could prove important to both program evaluators and clinicians. It could provide a meaningful first step towards obtaining normative data about disabilities across populations for integrated service planning purposes (Stineman, Ross, & Maislin, 2005). The core set is not intended to replace the more detailed setting- or condition-specific instruments

AIDS Care but, rather, to offer global indicators appropriate to linking and transmitting information across venues. This study will serve as a useful tool for identifying the nature and magnitude of health and social issues for those with HIV/AIDS. So also it will help in providing different perspectives about how services can be targeted to optimize the individuals ability to live a full life in the community. Study limitations There are a few limitations in this study. Since HIV/ AIDS is often characterized by unpredictable episodes of good health and poor health, a crosssectional study such as this may not be able to capture the whole picture of Self-Care among the participants. There are limitations in the nature of self-reported diagnoses. Participants may have trouble recalling the presence or absence of impairments, limitations or restrictions. Although there was no direct incentive, participants may be biased towards increased reporting of problems as they may feel that this would be beneficial for them. Despite these limitations, this survey represents one of few attempts to collect information on this scale. Furthermore, this is one of the first studies to systematically quantify levels of disablement among persons living with HIV. We should have also validated the Self-Care assessment of people living with HIV/AIDS with other established assessment instruments, such as the Functional Independence Measurement (FIM), Wechsler Intelligence Scale for Children Revised (WISC-R), Wechsler Adult Intelligence Scale Revised (WAIS-R), Gross Motor Function Measure (GMFM), but Battaglia et al. (2004) found a highly significant correlation between all the selected ICF Activity and Participation domains and the above assessment instruments. The age group analysis could have given a better option, since age co-morbidity increases the problems of self-care. Inter-rater reliability is one of the problems in such a type of study, but in our study Pilot testing was done to find the inter-rater reliability and it was found that Self-Care inter-rater reliability was high; our study was conducted by trained and experienced evaluators who performed the measurements, which further reduces the errors, and some studies have shown that the Domain Self-Care in Component Activities and Participation of the ICF has results that show Independent raters reached high rates of agreement, as seen in Ogonowski, Kronk, Rice and Feldman (2004). The existing version of the Comprehensive ICF Core Set for HIV could be confirmed only from the selected category. A qualitative research design may have

1103

conveyed more in-depth information regarding selfcare disability among participants. Limitations of the study include the somewhat homogeneous nature of the participants, which affects the generalizability of these findings to other populations. Despite these limitations, this survey represents a large sample on this scale. Furthermore, this is one of the first studies to systematically quantify levels of disablement among persons living with HIV. In this study, the Self-Care domain inter-rater reliability was high as the evaluation was conducted by an experienced evaluator. Research conducted by Okochi, Utsunomiya and Takahashi (2005) also emphasized that the reproducibility statistics improved when experienced evaluators performed the measurements. Conclusion Given the diversity of the feature and degree of selfcare disablement among individuals with HIV/AIDS in different parts of the world, future joint efforts of research, incorporating a greater number of field trials, case studies, or both, will be helpful in further scrutinizing the practical usefulness of the ICF in the field. Moreover, there is also a need for accumulated studies or users feedback that would help to determine comprehensiveness and appropriateness of the ICF codes and qualifiers in assessing and identifying the magnitude of diverse disablements encountered by different kinds of disease or health problems. As HIV disease has become a more lifelong, unpredictable but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns. The routine collection of this core set of functions could enhance decision-making at the client, professional, organizational and policy levels, encouraging cooperation among the medical and social service sectors when caring for people with disabilities (Stineman et al., 2005).

Downloaded By: [Zahir] At: 10:29 1 September 2009

References
Anandan, N., Braveman, B., Kielhofner, G., & Forsyth, K. (2006). Impairments and perceived competence in persons living with HIV/AIDS. Work, 27, 255266. Battaglia, M., Russo, E., Bolla, A., Chiusso, A., Bertelli, S., Pellegri, A., et al. (2004). International classication of functioning, disability and health in a cohort of children with cognitive, motor and complex disabilities. Developmental Medicine & Child Neurology, 46, 98106.

1104

A.M Gaidhane et al.


International Journal of Rehabilitation Research, 28, 93102. Stineman, M.G., Ross, R.N., & Maislin, G. (2005). Functional status measures for integrating medical and social care. International Journal of Integrated Care, 5, Article e07. Retrieved May 10, 2007, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool 0pubmed&pubmedid016773164 Vosvick, M., Koopman, C., Gore-Felton, C., Carl, T., John, K., & Spiegel, D. (2003). Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDS. Psychosomatics, 44, 5158. Wig, N., Lekshmi, R., Pal, H., Ahuja, V., Mittal, C.M., & Agarwal, S.K. (2006). The impact of HIV/AIDS on the quality of life: A cross sectional study in north India. Indian Journal Medical Science, 60, 312. World Health Organization. (2001). ICF: International Classication of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/classications/icf/en/ World Health Organization. (2002). Home-based long-term care. Report of a WHO Study Group. Geneva, Switzerland: World Health Organization. Zonta, M.B., Almeida, S. M., Carvalho, M.T.M., Werneck, L.C. (2005). Evaluation of AIDS related disability in a general hospital in Southern, Brazil. Brazilian Journal of Infectious Diseases, 9, 479488. Zonta, M.B., Almeida, S.M., Carvalho, M.T.M., et al. (2003). Functional assessment of patients with AIDS disease. Brazil Journal of Infectious Disease, 7, 301 306. Zonta, M.B, & Almeda, S.M. (2005). Evaluation of AIDSrelated disability in a general hospital in southern, Brazil. Brazilian Journal of Infectious Diseases, 9, 479 48.

Downloaded By: [Zahir] At: 10:29 1 September 2009

Hwang, J.-L., & Nochajski, S.M. (2003). The International Classication of Function, Disability and Health (ICF) and its application with AIDS. Journal of Rehabilitation, 69, Article e04. Retrieved January 11, 2007, from http://www.encyclopedia.com/doc/1G1-110802870.html Hebert, R., & Veil, A. (2004). Monitoring the degree of implementation of an integrated delivery system. International Journal of Integrated Care, 20, Article e04. Retrieved February 21, 2007, from URL: http:// www.ijic.org/archive.html Libman, H., & Stein, M.D. (2003). Primary care of HIV disease. In H. Libman, & H.J. Makadon (Eds.), ACP therapy. Vol. 1: HIV (2nd ed., p. 39). Mumbai: Aramuc Scientic Communication Private Ltd. Mumba, M. (2005). Physical disabilities among adults with HIV/AIDS being managed by the Makeni home-based carers in Lusaka, Zambia. (Master of Science, Minithesis, University of Western Cape, 2005. Retrieved on 23rd February 2007, from http://ww3.uwc.ac.za/docs/ %20Library/Theses/Theses%202005%201st%20Grad/ Mumba_m.pdf Ogonowski, J., Kronk, R., Rice, C., & Feldman, H. (2004). Inter-rater reliability in assigning ICF codes to children with disabilities. Disability & Rehabilitation, 26, 353 361. Okochi, J., Utsunomiya, S., & Takahashi, T. (2005). Health measurement using the ICF: Test-retest reliability study of ICF codes and qualiers in geriatric care. Health Quality Life Outcomes, 3, 46. Rusch, M., Nixon, S., Schilder, A., Braitstein, P., Chan, K., & Hogg, R. (2004). Impairments, activity limitations and participation restrictions: Prevalence and associations among persons living with HIV/AIDS in British Columbia. Health Quality Life Outcomes, 2, 46. Schuntermann, M.F. (2005). The implementation of the International Classication of Functioning, Disability and Health in Germany: Experiences and problems.

Das könnte Ihnen auch gefallen