S-4-04-02
OUTCOME MEASUREMENT IN TECHNICAL AIDS: INTRODUCTION OF THE REHABILITATION TECHNOLOGY USEABILITY MODEL (RTUM)
Grady, Johanna H. (Roessingh Rehabilitation Centre, Enschede, the Netherlands)
Product evaluation of technical aids is mainly directed on material/construction and biomechanical features. Relatively little attention is paid to the opinion of the user. Integral product evaluations are missing. There is a lack of insight in the actual use of technical aids which can be actually explained. To provide the missing insight the RTUM has been developed:
The actual use of technical aids is determined by the attitude of the user with respect to the product. This attitude is the result of the perceived (cognitively) and experienced (affectively) usefulness and ease of use based on the interaction of user - product in his environment. The concerned interaction is influenced by the outcome of the delivery process (and training) of the product. Per product each of the components of the RTUM has to be studied with help of current or new measurement instruments on impairment, disability and handicap level.
S-4-04-03
DEVELOPMENT OF THE FIM+FAM AS A COMMON LANGUAGE IN DISABILITY MEASUREMENT IN THE UK.
Lynne Turner-Stokes on behalf of the UK FIM+FAM Users group.
(Northwick Park Hospital UK)
The Functional Assessment Measure (FAM) adds 12 items to the Functional Independence Measure (FIM) and is widely used as a global disability measure to assess outcome in brain injury rehabilitation. However, its use is limited by poor reliability in some of the FAM items.
Objective: In this development project, the UK FIM+FAM Users group was set up to explore how the scale may be adapted for use as a common language disability measure in the UK.
Methods and results: A pole of users showed a high level of agreement in identifying 10 items which were particularly subjective or difficult to score in routine clinical use. These were, in rank order: Problem Solving, Adjustment to Limitations, Emotion, Employability, Social Interaction, Community Mobility, Safety Judgement, Attention, Speech Intelligibility, Comprehension. Rasch analysis of a preliminary dataset of 360 scores demonstrated misfit of some FAM items among the FIM subscales in which they have been placed.
The identified subjective items have been reviewed individually and changes to the tree structure have been made to reduce subjectivity. Problem solving and Social interaction are FIM items and may not themselves be changes, but task batteries have been developed to improve objectivity of scoring. Reliability studies are underway to assess the impact of these changes.
Conclusion: The programme is still underway, but has been useful in bringing together users from all over the UK to ensure consistent use and development of the FIM+FAM. Many of the lessons learned will be relevant to our colleagues elsewhere in the world.
