F-3-17-03
SCORING THE FUNCTIONAL INDEPENDENCE MEASURE USING A QUESTIONNAIRE.
Tetsuo Ota, Kazuhisa Domen, Meigen Liu, Shigeru Sonoda and Naoichi Chino (Keio University, Tokyo, Japan)
The Functional Independence Measure (FIM) is used as one of the most useful methods for evaluating inpatients' activity of daily living (ADL) in many hospitals in Japan.
But it is said that the number of patients who require the help of others for daily life in their homes will increase in the coming society of aged people. So it is important for physiatrists to know the ADL of the outpatients. But it takes a great deal of labor to evaluate the outpatients' FIM score even by a trained rator visiting their homes.
Therefore, we made a questionnaire to score the FIM of the patients who lived in their homes, even by an untrained person. And we studied the reliability of that questionnaire in stroke patients, comparing the FIM score evaluated by a trained rator with results from the questionnaire using a weighted kappa. The weighted kappa is more than 0.80 except for the items of eating, comprehension, social interaction and problem solving. And the intraclass correlation coefficient (ICC) of the total FIM score is 0.99.
We conclude that we could evaluate the functional independence of the patients who lived in their homes by using this questionnaire, without visiting them. And actually we use this questionnaire to determine the disability of the patients who take part in community-based rehabilitation.
F-3-17-04
CAN A BARTHEL SCORE BE DERIVED FROM THE FIM?
Kyaw Nyein, Lynne Turner-Stokes (Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom)
The purpose of this study was to establish whether a Barthel score derived by translation from the motor items of the Functional Independence Measure (FIM) would equate to the directly scored measure.
With careful reference to the scoring manuals of both measures, we have developed conversion criteria which allow a Barthel score to be derived from motor item scores on the FIM scale. The derived Barthel score was compared with the directly scored measure in 40 consecutive patients on our unit. Both scores were undertaken by a multi-disciplinary team who were unaware of the conversion criteria. Patients were scored either on admission or discharge to ensure comparison over the full range of the score.
There was a high level of correlation between the total scores (Spearman rank rho.98) and no significant differences between scores for any of the individual items (Wilcoxon signed rank test). In 15 patients (37.5%), there was absolute agreement in all 10 items between the two scores and in a further 14 patients (35%), there was agreement in nine out of 10 items.
The study demonstrates that FIM motor item scores can be directly translated to Barthel scores through fixed conversions and is a step in the right direction towards achieving a universal language in the measurement of disability.
