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Europa Medicophysica 2001 March;37(1):39-50

Copyright © 2001 EDIZIONI MINERVA MEDICA

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.