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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2011 Marzo;47(1):25-34
Latent Class Factor Analysis of the Functional Independence Measure confirmed four distinct dimensions in patients undergoing neurological rehabilitation
Scheuringer M. 1, Grill E. 2,3, Boldt C. 4, Stucki G. 3,5
1 Outcomes Research, MSD Sharp & Dohme GmbH, Haar, Germany;
2 Institute for Health and Rehabilitation Sciences (IHRS), Ludwig Maximilians University, Munich, Germany;
3 ICF Research Branch of WHO FIC CC (DIMDI) at SPF Nottwil, Switzerland and, IHRS, Ludwig Maximilians University, Munich, Germany;
4 Swiss Paraplegic Research, Nottwil, Switzerland;
5 Seminar of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
AIM: The FIM™ instrument is broadly applied in varying rehabilitation services for outcome assessment. Thus, it is important to examine its applicability for services which may differ from the situations and patients for which it was originally developed. The aims of the present study were to examine 1) whether the four FIM™ dimensions “activities of daily living”, “sphincter management”, “mobility”, and “executive function” can be retrieved by Latent Class Factor Analysis (LCFA); and 2) whether the four dimensions show floor effects in patients with acquired brain injuries undergoing intensive post-acute rehabilitation.
METHODS: We analyzed the FIM™ data of 269 patients with acquired brain injuries undergoing intensive post-acute rehabilitation. To examine the dimensional structure of the FIM™ instrument we carried out LCFA. Cronbach’s alpha was used to measure the internal consistency. We examined the distribution of the dimension scores to identify floor effects.
RESULTS: LCFA confirmed the postulated four dimensions. The explained variance of items assigned to the four dimensions ranged from 46% to 89%. Cronbach’s alpha coefficients of the four subscales ranged from 0.94 to 0.96. The percentage of patients scoring the minimum possible score in each of the retrieved dimensions ranged from 22.3% to 47.9%.
CONCLUSION: When applying the FIM™ instrument to patients undergoing intensive neurological rehabilitation its dimensionality should be kept in mind. For some patients this outcome measure might not be discriminative enough due to floor effects.