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Stroke Patient Outcomes: Does an Integrated Delivery Model of Care Make a Difference?
Published in Margaret A. Perkinson, Kathryn L. Braun, Teaching Students Geriatric Research, 2021
Barudi Mosimaneotsile, Kathryn L. Braun, Carol Tokishi
Five outcome variables included LOS, FIM-discharge score, FIM-change score, FIM-efficiency, and discharge destination. LOS represents the number of days the patient spent at REHAB and was calculated by subtracting the admission date from the discharge date. The Functional Independence Measure has been used nationwide as a generic assessment tool for patients receiving rehabilitation services and has been shown to be highly reliable and valid (Dodds et al. 1993). The FIM instrument measures 18 categories: 8 items pertain to Activities of Daily Living (ADL) skills (e.g., ability to feed, bathe, dress, groom, and toilet oneself), 5 items pertain to mobility (e.g., ability to walk, transfer, and climb stairs), and 5 items pertain to cognitive functioning (comprehension, expression, social interaction, problem solving, and memory). Each of the 18 items is measured on a scale from 1 (totally dependent) to 7 (totally independent). Total FIM scores are calculated by summing values of the 18 domains, and range from 18 (totally dependent in all items) to 126 (totally independent in all items). A FIM-change score is calculated by subtracting the FIM-admission score from the FIM-discharge score. Discharge destinations were home, nursing home, and hospital.
Measuring and Quantifying Outcomes
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Although the ability of a patient to perform ADLs is often a subcategory of performance status, there are specific measures designed to capture the level of performance in each of the specific ADL categories. The Functional Independence Measure (FIM, 18-items rated on a 7-point ordinal scale [1: total assist to 7: complete independence]), Katz Index of Independence in ADL (6: high, 0: low), and the Barthel Index (0–100) are frequently used ADL assessments.41–43
Allied health records in the electronic age
Published in Robert Jones, Fiona Jenkins, Penny Humphris, Karen Middleton, Managing Money, Measurement and Marketing in the Allied Health Professions, 2018
The DH has published an AHP Data set22 which aims to help AHPs to collect data relevant to the patient journey. Data is grouped into data categories of patient, organisation, referral, waiting time, patient contact and discharge. The 80 items are not mandated and advice is given regarding the reason a service may want to collect this data. The Australian National Allied Health Casemix Committee23 has developed a Health Activity Hierarchy to understand all the health activities undertaken by AHPs as part of their workload. To provide standardised data to complete this hierarchy they have also developed the Australian Allied Health Minimum Dataset and Rehabilitation Outcomes.24 Canada has a similar model of care provision to Australia and they collaborate on Rehabilitation Outcomes – both using the Functional Independence Measure25 to evaluate functional outcomes. Data systems are highly developed through the Canadian Institute of Health Information.26 Data sets are developed for acute care; home care and continuing care.
The determinants of motorized mobility scooter driving ability after a stroke
Published in Disability and Rehabilitation, 2021
Fang-Ling Ku, Wei-Chung Chen, Ming-De Chen, Szu-Ya Tung, Tien-Wen Chen, Chiu-Chin Tsai
The Functional Independence Measure was used to measure the functions of activities of daily living. It has been reported that car driving ability and activities of daily living status are positively correlated [37]. Thus, we assumed there was association between mobility scooter driving ability and activities of daily living status. The Functional Independence Measure includes 18 items that measure performance in 6 areas (self-care, sphincter control, transfers, locomotion, communication, and social cognition). These areas are further defined into a motor subscale (the first four areas) and a cognitive subscale (the last two areas). Items are scored on a seven-point ordinal scale (1 = complete dependence, 7 = complete independence), with a total of score ranging from 18 to 126. The Functional Independence Measure is a measurement with satisfactory reliability and validity for stroke survivors [38,39].
Vitality index is a predictor of the improvement in the functional independence measure score in subacute stroke patients with cognitive impairment
Published in Neurological Research, 2021
Daisuke Ito, Naoki Mori, Ayaka Shimizu, Ayako Fuji, Sachiko Sakata, Kunitsugu Kondo, Michiyuki Kawakami
Functional disability was assessed using the Functional Independence Measure (FIM) [29]. The FIM comprises 13 motor subscales (FIM-motor) and 5 cognitive subscales (FIM-cognitive). The FIM-motor consists of the following four categories: self-care (eating, grooming, bathing, dressing-upper body, dressing-lower body, and toileting), sphincter control (bladder management and bowel management), transfers (bed/chair/wheelchair, toilet, and tub/shower), and locomotion (walk/wheelchair and stairs). The FIM-cognitive consists of the following two categories: communication (comprehension and expression) and social cognition (social interaction, problem solving, and memory). Each item has a 7-grade scale ranging from 1 point (total assistance or not testable) to 7 points (complete independence). The total score is 18–126 points, 13–91 points, and 5–35 points for the total FIM, FIM-motor, FIM-cognitive, respectively, with a higher score representing greater functional independence. The validity and reliability of this measurement has been established for patients with stroke [30].
Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC
Published in Neuropsychological Rehabilitation, 2020
Nick Alderman, Aimee E Pink, Claire Williams, Sara da Silva Ramos, Michael Oddy, Caroline Knight, Keith G Jenkins, Michael P Barnes, Chloë Hayward
Functional Independence Measure and Functional Assessment Measure UK – 2.2 (FIM + FAM; Turner-Stokes, Nyein, Turner-Stokes, & Gatehouse, 1999): Designed to provide a global index of disability, the UK FIM + FAM consists of 30 items evaluated on a 7-point ordinal scale, ranging from totally dependent (1) to completely independent (7), with higher total scores indicative of less disability. Items are organized across six subscales (nine self-care; seven transfers and mobility; five communication; four psychosocial, five cognition), although items tend to load onto two main factors: Motor (16 items, score range 16–112), and Cognitive (14 items, score range 14–98; Nayar, Vanderstay, Siegert, & Turner-Stokes, 2016; Turner-Stokes & Siegert, 2013). For this reason, only Total, Motor and Cognitive scores are utilized in the current study. In addition, a separate 6-item “Extended Activities of Daily Living” scale can be used (EADL; e.g., meal preparation, housework). The FIM + FAM has been part of the UKROC dataset since its inception and has robust psychometric properties (see Nayar et al., 2016; Tate, 2010, pp. 440–441; Turner-Stokes & Siegert, 2013). Moderate levels of responsiveness have also been reported in samples of patients undergoing specialist rehabilitation following stroke (Nayar et al., 2016) and in general inpatient neurorehabilitation populations (Turner-Stokes & Siegert, 2013).