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Pre-AIDS physical disability: data from the AIDS Time-Oriented Health Outcome Study
M W O'Dell1, H B Hubert, D P Lubeck
1Department of Physical Medicine and Rehabilitation, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
Objective:
To document the severity and correlates of perceived physical disability in a group of persons with HIV infection before an AIDS-defining illness, and to compare disability levels with a group of adults not infected with HIV.
Design:
Observational cross-sectional study.
Setting:
Community-based sample in California recruited through the AIDS Time-Oriented Health Outcome Study.
Participants:
Five hundred thirty-one asymptomatic and 345 symptomatic persons with HIV infection, primarily Caucasian, well-educated, homosexual and bisexual men. The control group consisted of 2,567 persons evaluated in the National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study, a national probability sample of civilian, noninstitutionalized persons between ages 1 and 74 years living in the United States.
Main Outcome Measure:
Perceived physical disability measured by the HIV Health Assessment Questionnaire, a self-administered questionnaire that measures perceived disability in eight areas of mobility and activities of daily living.
Results:
There were few significant differences between the asymptomatic and symptomatic groups. Total disability scores demonstrated a moderately strong relationship to number of symptoms, overall health status, employment, and Medical Outcomes Study-HIV fatigue index (r = -.39 to .59; p < .001). With few exceptions, less than 10% of the cohort perceived limitations to any degree and no more than 2% reported being "unable to perform" in a given functional category. However, both groups demonstrated somewhat higher levels of physical dysfunction than an age-, race-, and education-matched comparison group of adults without HIV infection.
Conclusions:
Persons with HIV infection before an AIDS-defining illness demonstrate relatively low levels of physical dysfunction. When present, deficits tend to occur among instrumental activities of daily living. Despite the relatively low levels, perceived disability among the pre-AIDS sample is somewhat higher than that of the general population. Implications for functional assessment, disability screening, and future HIV disability research are discussed.