Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure

This study investigated the long-term functional changes in patients with moderate-to-severe ischemic stroke. In addition, we investigated whether there was a difference between the modified Barthel Index (MBI) and Functional Independence Measure (FIM) according to severity. To evaluate the changes in the long-term functional independence of the subjects, six evaluations were conducted over 2 years, and the evaluation was performed using MBI and FIM. A total of 798 participants participated in this study, of which 673 were classified as moderate and 125 as severe. During the first 3 months, the moderate group showed greater recovery than the severe group. The period of significant change in the National Institutes of Health Stroke Scale (NIHSS) score was up to 6 months after onset in the moderate group, and up to 3 months after onset in the severe group. In the severe group, MBI evaluation showed significant changes up to 6 months after onset, whereas FIM showed significant changes up to 18-24 months. Our results showed that functional recovery of patients with ischemic stroke in the 3 months after onset was greater in the moderate group than in the severe group. FIM is more appropriate than MBI for evaluating the functional status of patients with severe stroke.

Reliability and validity of the adult alpha functional independence measure instrument in England

It is essential for neuroscience nurses everywhere to have reliable and valid instruments with which to measure functional ability, but reliability and validity have yet to be reported on the adult Alpha Functional Independence Measure (AlphaFIM) in England. The aim of this study was to determine the reliability and validity of the adult AlphaFIM instrument. Reliability was estimated using Cronbach's alpha. Validity was examined by comparing adult AlphaFIM instrument scores with Barthel Index scores and by factor analysis in a group of 551 patients admitted to acute medical units. Cronbach's alpha for the 6-item adult AlphaFIM instrument was .90. The correlation between the adult AlphaFIM instrument and the Barthel Index was .68 (p < .001). The factor analysis supported a one-factor solution for the 6-item adult AlphaFIM instrument. This is the first report of reliability and validity on this instrument. The adult AlphaFIM instrument appears to be a reliable and valid tool with which to measure functional ability in an acute medical geriatric population in England.

Geriatric depression, medical diagnosis, and functional recovery during acute rehabilitation

OBJECTIVE

To examine and compare the prevalence and functional impact of depressive symptoms for older adult stroke and nonstroke rehabilitation inpatients.

DESIGN

Case-control study examining functional outcome using a 2 (stroke, nonstroke) by 2 (depression, no depression) design.

SETTING

Urban hospital rehabilitation unit.

PARTICIPANTS

A total of 509 rehabilitation inpatients (age, > or = 60 y) were included and grouped by diagnosis of stroke (n=207) and nonstroke (n=302).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Geriatric Depression Scale and FIM instrument. Analysis of covariance procedures examined the impact of depressive symptoms on discharge functional ability controlling for age, sex, admission functional ability, and hospital length of stay.

RESULTS

Prevalence of depressive symptoms was similar for stroke (31.8%) and nonstroke (31.5%) and negatively associated with functional ability at discharge for both groups. Overall, the stroke and nonstroke groups did not differ significantly with respect to functional recovery.

CONCLUSIONS

Depression, and its impact on acute rehabilitation, is significantly related to functional recovery but does not differ in its frequency or impact for stroke patients. Because depressive symptoms do not appear to discriminate across diagnostic groups, routine screening for depression is recommended for all rehabilitation inpatients.

A comparison of the Barthel Index and the Functional Independence Measure as outcome measures in stroke rehabilitation: patterns of disability scale usage in clinical trials

In order to compare the frequency and patterns of use of the Barthel Index (BI) and Functional Independence Measure (FIM) in stroke rehabilitation trials, all randomized controlled trials (RCTs) of stroke rehabilitation published between 1968 and 2002 were identified and reviewed to determine the frequency with which the BI and FIM measures were used relative to other measures of disability. The date and location of each study citing either the FIM or the BI were also recorded. Studies were assigned ratings of methodological quality based on the physiotherapy evidence database (PEDro) scoring system. Comparisons of the age, frequency and continents of origin and methodological quality of the studies were explored. Results indicate that the BI and FIM were the most common measures of disability used in RCTs examining stroke rehabilitation. However, the BI was used more often than the FIM (n=86, P<0.001) and was cited in trials of superior quality (P=0.005). Studies from North America were more likely to use the FIM compared with European studies (n=24, P<0.001). Publications citing the BI were significantly more recent when originating in Europe as opposed to North America (P=0.023). These results provide insight into current patterns of scale use in stroke rehabilitation research.

The work of rehabilitation

PURPOSE

To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation.

METHOD

A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000--2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores.

RESULTS

Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM.

CONCLUSIONS

The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.