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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
A Journal on Physical Medicine and Rehabilitation after Pathological Events
Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2001 March;37(1):39-50
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.