Reliability of an interview approach to the Functional Independence Measure

Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living persons

OBJECTIVE

To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview.

DESIGN

Comparative study of a convenience sample.

SUBJECTS

Results in 36 persons with stroke >10 years previously.

METHODS

Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1-2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items).

RESULTS

There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons.

CONCLUSION

The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results.

Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Background

To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives.

Methods

Adults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed.

Results

A total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives.

Conclusion

Patients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.

Predicting posthospital recovery of physical function among older adults after lower extremity surgery in a short-stay skilled nursing facility

This study describes the posthospital recovery of physical function among 131 older adults after lower extremity surgery in a short-stay skilled nursing facility (SNF), and identifies admission factors predicting physical function at discharge. Multiple regression analyses found that older adults with low baseline physical function, pressure ulcer, malnutrition, memory loss upon admission, and not enough physical therapy had poor physical function at the time of discharge from the facility. This study generated the following recommendations for nurses working in short-stay SNFs: (1) screen all posthospital residents at admission with predictors to identify people at risk for physical functional decline, (2) design and implement targeted nursing and rehabilitation interventions to improve physical function, and (3) develop discharge plans that provide ongoing monitoring and interventions for community or nursing home nurses.

Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial

BACKGROUND AND AIMS

There are few studies published that combine the interventions of physical training and nutrition. The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community- dwelling elderly people over the age of 75.

METHODS

Ninety-six community-dwelling elderly people (58 women) were randomized to four different groups: i) a physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline subjects were screened for physical performance such as muscle strength, balance, mobility and activities of daily living, as well as nutritional aspects such as energy intake, body weight and fat-free mass. These measurements were repeated immediately after the intervention, which lasted for 12 weeks, and after another 6 months.

RESULTS

The intention-to-treat analysis indicated significant improvements in lower- extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up. There were small significant changes for some of the balance measurements in the training group without nutrition treatment. The nutrition intervention did not show any significant results.

CONCLUSIONS

This study shows the positive effect on lower-extremity muscle strength directly after the intervention. Balance training most probably needs to be more individualized in order to be effective for frail elderly people. Further studies are needed, with larger sample sizes, to investigate the effects of these types of interventions before any further conclusions can be drawn.

Do Objective Measurements of Physical Function in Ambulatory Nursing Home Women Improve Assessment of Functional Status?

OBJECTIVE

To compare the functional status of ambulatory women in four academic nursing homes using standardized rating scales and physical performance measures used in community settings.

DESIGN

Observational cohort.

PARTICIPANTS

Women older than 65 years, ambulatory with or without an assistive device.

INTERVENTIONS

Direct comparison of the Functional Independence Measure and the Performance Self Maintenance Score with objective measure of the Get-up-and-go test, a six minute walk, and a six meter walk.

RESULTS

Two variables, the gait speed and creatinine clearance, correctly classified 80% of subjects with higher functional status defined by subjective rating scales.

CONCLUSION

Although gait speed calculated by a six meter walk is easily performed and highly correlated with subjectively assessed functional status, the majority of these ambulatory women nursing home residents exceeded the population means for each of the performance-based physical function measures.

[Issues involved with supply of medical and hygienic materials to home care patients]

Questionnaires were mailed to doctors and nurses who are involved in home care to survey their observations on medical and hygienic materials and its supply to home care patients. Some of the survey items, such as problems encountered frequently, areas where an improvement was needed most and concerns that are often raised in suppling of medical and hygienic materials for home care patients, were analyzed by the Berelson's content analysis method to observe problems in suppling adequate medical and hygienic materials. As a result, 5 categories and 17 subcategories were formed. The recognized future issues were: policies concerning support extended to medical organizations and disseminate information of the system, which medical and hygienic materials supplied to home care patients.

Agreement Between Patient and Proxy Responses During Recovery After Hip Fracture: Evidence for the FIM Instrument

OBJECTIVE

To evaluate the agreement between patient and proxy responses of the FIM instrument at 4 different periods of time during the first 6 months after hip fracture.

DESIGN

Prospective cohort study.

SETTING

A large urban health region with 2 tertiary hospitals that treat hip fractures.

PARTICIPANTS

Patients (n=137) who were 65 years or older, admitted to the health region with a primary diagnosis of hip fracture, who had Mini-Mental State Examination scores greater than 17. Family caregivers (n=137) participated as proxy respondents.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The FIM instrument. Agreement was evaluated at each of the 4 assessments during the 6-month follow-up after hip fracture using intraclass correlation coefficient.

RESULTS

FIM scores improved over the 6 months with the greatest improvement occurring within the first month of recovery. Agreement was higher for more observable activities than less observable ones. The magnitude of agreement improved over the 6 months with the proportion of clinically important systematic differences decreasing over time. Agreement for change scores was lower than the agreement at each of the 4 assessments.

CONCLUSIONS

Patient-proxy agreement levels are acceptable; the agreement varies with the subscale and the recovery phase. Substitution of proxy for patient responses across time may be used guardedly when patient responses are missing.

The first year after successful cardiac resuscitation:

AIM

To assess cognitive function, activities of daily living (ADL) and living situation longitudinally up to 1 year after cardiac arrest.

SETTING

University hospital.

MATERIALS

The study continued for 3 years and consecutive patients (18-75 years of age) who survived resuscitation were included.

METHOD

A longitudinal study with examinations using the National Institute of Health Stroke Scale for assessing brain damage, along with the Mini Mental State Examination. To assess ADL, we used the Functional Independence Measure and the Instrumental Activity Measure. Life satisfaction was assessed, together with health-related quality of life. Social status and vocational status were recorded.

RESULTS

Mortality was high during the first 90 days (31%). After discharge, not much improvement was seen in cognitive function. This was reflected in reduced dependency in ADL. Work capacity at 1 year was only 13%. The health related quality of life showed great improvement during the first year, being almost the same as for Swedish reference values.

CONCLUSIONS

Most of the improvement resulting in the independence of ADL occurred during the first 45 days. It is important to give the next of kin information about the patient's progress and need for assistance in order to enable them to plan for the future before discharge.

Inter-rater reliability of the Pennsylvania independent monitoring for quality program's essential data elements scale

The purpose of the independent monitoring for quality (IM4Q) program is to bridge communication between individuals with mental retardation and the service providers on whom they rely. The IM4Q program uses an interview (essential data elements survey) to gather information about the lives of individuals with mental retardation. Collaboration between individuals with mental retardation, family members, and community members provides diverse interviewing teams. This study evaluates inter-rater reliability of the essential data elements (EDE) survey. Findings show that 73 of the 74 questions had monitor agreement scores of 85% or higher Inter-rater reliability of the Pennsylvania independent monitoring for quality program's essential data elements scale.

Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation

OBJECTIVE

To examine the reliability of assessment with the Catz-Itzkovich Spinal Cord Independence Measure II (SCIM II) by interview and compare the findings with assessment by observation.

DESIGN

In a cohort, comparative study, 28 inpatients with spinal cord lesions were assessed by two nurses using the Catz-Itzkovich SCIM II (interview) and by a multidisciplinary team (observation).

RESULTS

Total agreement between interviewers ranged from 50% to 80% (Kappa coefficients 0.40-0.60). Pearson's coefficients of the correlation between scores obtained for the various SCIM subscales by interview or observation were 0.765-0.940 (P < 0.0001). The differences in mean scores obtained between the interview and observation methods were small and not statistically significant for most of the subscales.

CONCLUSIONS

The results support the reliability of the Catz-Itzkovich SCIM assessment by interview and show it to be comparable with assessment by observation. The SCIM II interview may serve as an accurate measure of daily function in patients with spinal cord injury. However, with the sample of the study being relatively small, a larger scale examination is needed to generalize the results.