WIHS QxQ Form 7: Physical Exam – 10/01/02a Page 1 of 13 WOMEN’S INTERAGENCY HIV STUDY QUESTION BY QUESTION SPECIFICATIONS FORM 7: PHYSICAL EXAM Guidelines for completing Form 07, “Physical Exam.” Note that not every question is detailed in these QxQ’s, but only those requiring further explanation than that listed on Form 7. General Instructions: 1. Use the form version dated 10/01/02. 2. All dates should be recorded in the MM/DD/YY format. 3. Times should be recorded in HH:MM format. Remember to use leading zeros, e.g., 08:00. 4. Participants should remove all clothing, except underwear. Shoes should be removed; thin socks may be worn, if participant desires. Paper or lightweight cotton gowns should be worn during the entire exam. Indicators for the beginning and end of all subforms have been added to the form. This has been done for data entry purposes only and will not affect how the form is completed. PARTICIPANT INFORMATION This section at the beginning of the form should be completed before beginning the physical exam. Remember to verify with the participant the date of her birth. Record the actual time you began the physical exam in the space provided for “Time Module Began” and the actual time you ended the exam in the space denoted “Time Module Ended.” SECTION A: GENERAL PHYSICAL CHARACTERISTICS AND BODY HABITUS A1a. Weight: A balance scale should be used, and all weights should be recorded in pounds (LBS). The scale should be level and on a firm surface (not a carpet). Be sure the scale is balanced so that the indicator is at zero when no weight is on the scale. The participant should be instructed to stand in the middle of the platform of the balance scale with head erect and eyes looking straight ahead. Adjust the weight on the indicator until it is balanced. The weight should be recorded in pounds to the nearest 1.0 lb. Please do not make any conversions from kilograms. Have the participant step off the scale, reset the balance to zero and repeat. If measures differ by more than 1.0 lb., repeat a third time. Always record the first measure that most closely matches the third measure. For example, if only two measures were taken (i.e., the first and second measures were within 1.0 lb. of one another) record the first measure taken. If three measures were taken and the second and the third are within 1.0 lb. of each other, record the second measure. If three measures were taken and the first and the third measure were within 1.0 lb. of each other, record the first measure. A1b. Height: Participant should stand with head in Frankfort horizontal plane, shoulders relaxed, arms at sides, legs straight, and feet flat. The participant should take a deep breath and stand as tall a possible. Enter the height of the Participant in inches. Round off to the nearest whole number and write in the numeric value. Please do not do any conversions. NOTE: Frankfort horizontal plane is described by NHANES as: “The head is in the Frankfort plane when the horizontal line from ear canal to the lower border of the orbit of the eye is parallel to the floor and perpendicular to the vertical backboard.”WIHS QxQ Form 7: Physical Exam – 10/01/02a Page 2 of 13 A2. This question is asking for the examiner’s perception at the time of the exam based on the overall appearance of the participant, not based on the participant’s HIV status, perceptions, or complaints. Indications of acute illness can include: diaphoresis/excessive sweating, respiratory distress or labored breathing, altered state of consciousness (acute/excess anxiety, lethargy, confusion, delirium), evidence of intense pain, and flushing. Indications of chronic illness can include: cachexia/significant weight loss and sallow/gray complexion. Circle only one category/code. A3a. Assess the participant’s general appearance using the categories/codes provided. Cachexia is suggested by general emaciation, evidence of significant weight loss, muscle wasting, and/or debility. Circle only one category/code. A3b. Indicate if the participant is pregnant. If she is, skip to Section B. A5. The visual assessment section of the physical exam includes clinician rating of fat distribution and other changes according to a scale with the following gradations: normal, mild, moderate and severe. Surveys in previous studies used a subjective rating system that was based on the opinion of the observer. While there are no absolute criteria, the WIHS study is providing a series of photographs with some gradations and descriptions (see WIHS website and below) to assist in the examination of the participant. The photographs and descriptions should be viewed as a guide to the evaluation. Some of the findings are similar to those found in people without HIV infection. If the participant fits into the average of the people that are seen, then choose Normal. For this portion of the exam, participants should wear a loose fitting hospital gown. The exam should be performed with the participant standing. The legs should be relaxed with both feet flat on the ground and the arms should be relaxed on either side. When examining the various body sites, please make sure the area can be well visualized. For instance, when examining the chest, please have the participant remove the top part of the gown, so that the chest can be well visualized. The following are definitions for mild, moderate, and severe used in a separate study looking at fat redistribution (HIV Outpatient Study (HOPS)): Mild: Only seen if looked for Moderate: Easily seen Severe: Obvious immediately Described below are specific descriptions for each of the points (other than normal) on the 7-point scale associated with each area of the body listed. Questions A5a, A5f, A5g concern the chest, upper back, and neck, respectively. Please use the following guidelines for all three of these locations: Severely fat: Fat obviously bulging outward; may have prominent folds Moderately fat: Prominent amount of fat Mildly fat: More fat than average on exam Mildly wasted: Little fat; musculature and veins may be visible Moderately wasted: Very little fat; musculature and veins may be prominent Severely wasted: Virtually no fat present; muscle bellies, tendons and bones may stand outWIHS QxQ Form 7: Physical Exam – 10/01/02a Page 3 of 13 Questions A5b (abdomen) and A5c (waist) focus on the abdomen.