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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2001 March;37(1):39-50


language: English

The FIM scale as a planning tool for medical, nursing and physiotherapy requirements in rehabilitation. Use in a recovery and functional rehabilitation unit at Merano Hospital

Tischler H., Platzer A., Vian P., Genetti B.

From the Recovery and Functional Rehabilitation Unit Merano Hospital, Merano, Italy *Explora, Research & Statistical Analysis, Vigodarzere (Padua), Italy


Background. To ­define a clas­sifi­ca­tion ­system for ­long-­term ­patients under­go­ing hos­pi­tal reha­bil­i­ta­tion ­that is sen­si­tive to dif­fer­enc­es in func­tion­al dam­age ­shown by indi­vid­u­al sub­jects; to quan­ti­fy the dai­ly require­ments for med­i­cal, nurs­ing and reha­bil­i­ta­tive assis­tance.
Methods. A ­study was ­made in a sam­ple ­group of 77 ­patients attend­ing the Recovery and Functional reha­bil­i­ta­tion ­unit at Merano Hospital (Alto Adige - Italy). The sur­vey last­ed a ­total of ­four ­weeks. Specific meas­ure­ment ­sheets ­were pre­pared for ­each pro­fes­sion­al fig­ure work­ing in the ­unit to quan­ti­fy the assis­tance activ­ities and ­times. The ­degree of dis­abil­ity in ­each ­patient was eval­u­at­ed ­using the FIM ­scale. The FIM ­scale meas­ures ­self-suf­fi­cien­cy in 18 every­day activ­ities. For ­each ­item the ­scale var­ies ­from 1 to 7 as ­self-suf­fi­cien­cy increas­es (pos­sible ­range 18-126).
Results. The sam­ple of ­patients stud­ied had a ­mean age of 63 ­years and main­ly pre­sent­ed pathol­o­gies affect­ing the oste­o­mus­cu­lar (60.5%) and car­di­oen­ce­phal­ic ­system (23.4%). The ­mean lev­el of dis­abil­ity in ­these ­patients result­ed in a FIM ­score of 100; ­this var­i­able was cor­re­lat­ed to the ­amount of assis­tance pro­vid­ed by nurs­ing ­staff and by the phys­io­ther­a­pist and ­speech ther­a­pist. Using ­binary seg­men­ta­tion anal­y­sis (­CART) the ­study ­defined two ­systems of clas­si­fy­ing ­patients ­into iso­re­source ­groups of nurs­ing ­care and phys­io­ther­a­py. The mod­el for nurs­ing assis­tance ­allows ­patients to be clas­si­fied in rela­tion to the com­bined FIM ­score for the ­items wash­ing, loco­mo­tion (­stairs) and rela­tion­al/cog­ni­tive (mem­o­ry) capac­ity. The dis­crim­i­nat­ing ­items in the clas­sifi­ca­tion ­system ­obtained for phys­io­ther­a­py assis­tance ­refer to per­i­neal ­hygiene and the cog­ni­tive capac­ity to ­resolve prob­lems. The var­i­ance ­explained by mod­els was respec­tive­ly 68.1% for nurs­ing assis­tance and 56.8% for phys­io­ther­a­py assis­tance, ­while the pre­dic­tive capac­ity of mod­els was respec­tive­ly 79% and 67%.
Discussion. The pre­dic­tive mod­els clas­si­fy ­patients ­into ­four iso­re­source ­groups for nurs­ing ­care and ­into ­three ­groups for phys­io­ther­a­py. By meas­ur­ing a few var­i­ables (respec­tive­ly two for phys­io­ther­a­py and ­three for nurs­ing) it is pos­sible to esti­mate the dai­ly assis­tance need­ed by ­patients. An addi­tion­al advan­tage of ­this meth­od is the rap­id and repro­du­cible clas­sifi­ca­tion of ­patients ­using not ­only diag­nos­tic, but ­also func­tion­al param­e­ters. The ­main lim­its of the ­study are the ­scanty ­nature of the sam­ple and the ­choice to use sin­gle ­items ­from the FIM ­scale ­instead of the over­all ­score, ­which ­makes it dif­fi­cult to gen­er­al­ise ­this clas­sifi­ca­tion ­system to oth­er oper­a­tion­al sit­u­a­tions.

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