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Print version ISSN 0004-282X
Arq. Neuro-Psiquiatr. vol.61 no.3A São Paulo Sept. 2003
Functional assessment of patients with AIDS (Abstract)*. Dissertation. Curitiba, 2003.
Marise Bueno Zonta**
Currently, with the advance achieved in the treatment of AIDS and an increase in survival rates, this illness is seen as chronic. The increase in survival rates is associated with the physical disability that occurs as a result of the illness, and can compromise the functional independence of the patients. Functional disability is a key to understanding the consequences of the disease and to defining the need for providing services.
The purpose of this study is to register and to describe the degree and types of disability seen in persons affected by AIDS, as well as to associate the inability with immunological and clinical data.
The study took place at Hospital de Clínicas of the Federal University of Paraná, where 120 inpatients diagnosed to be with AIDS were evaluated in the period of May/2000 July/2002. Each patient was evaluated only once. The functional evaluation consisted of an interview with the patient, a retrospective analysis of the hospital records, of a physical examination, and the application of scales that measures physical ability Karnofsky and modified Rankin Scale and functional ability, Functional Independence Measure (FIM) and Barthel Index. During the interview, the patients were questioned about the existence of disabilities, their beginning and relationship with other factors. The physical examination consists of the evaluation of muscular strength.
One hundred and two patients (85%) reported impaired physical activity and 70% complained of various degrees of weakness. Half of the population referred to the physical effort required for the performance of all their activities; 67% do not work and 44% gave up their jobs for reasons related to the infection; the muscle strength was altered in 43% and 46% complained about disabling neurological involvement. Based on Karnofsky's scale, the average was 70% (± 0.19), median 80%. Eighty percent (80%) was the most frequent ranking, which was found in 63 (52%) of them. According with Rankin's modified scale, 33 (28%) patients were considered independent, 72 (60%) partially dependents and 15 (12%) dependents. In accordance with the Barthel index, 67 (56%) were considered independent, 41 (34%) partially dependent; 12 (10%) were dependent. According with the FIM scale, 49 (58%) were considered independent and 36 (42%) dependent. The items most often requiring assistance were stair climbing, walking and transfers, which were the items that called for a greater effort to be performed. There was a statistical correlation between the inability measured by the scales and the higher rates of viral load (log) c/ml, lower rates of CD4+/ml counts and CD4+/CD8+. There was also a significant difference between inability and the greater number of months since AIDS had been diagnosed, the involvement of more than one set of systems in the definition of AIDS, involvement of the nervous system in the cause of hospitalization, muscle strength alteration, complaints of neurological involvement, complaints of weakness and with being unemployed.
We found a significant degree of inabilitng in patients hospitalized with AIDS, which means that it is important to focus attention on preventing and/or treating in order to keep the patients at the independence level for as long as possible, thus ensuring for them a better quality of life.
Key words: HIV infection, AIDS, functional independence, disability .
* Avaliação funcional em pacientes portadores de AIDS (Resumo). Dissertação de Mestrado, Universidade Federal do Paraná, UFPR (Área: Medicina Interna). Orientador: Sérgio Monteiro de Almeida.
** Address: Setor de Neurologia, Hospital de Clínicas UFPR, Rua General Carneiro 181 sala 1238, 80060-900 Curitiba PR, Brasil. E-mail: firstname.lastname@example.org