Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure

BACKGROUND The importance of evaluating disability outcome measures is well recognised. The Functional Independence Measure (FIM) was developed to be a more comprehensive and “sensitive” measure of disability than the Barthel Index (BI). Although the FIM is widely used and has been shown to be relia...

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Bibliographic Details
Published in:	Journal of neurology, neurosurgery and psychiatry Vol. 66; no. 4; pp. 480 - 484
Main Authors:	van der Putten, J J M F, Hobart, J C, Freeman, J A, Thompson, A J
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd 01-04-1999 BMJ BMJ Publishing Group LTD BMJ Group
Subjects:	Activities of Daily Living Adult Aged Barthel Index Biological and medical sciences Cerebrovascular Disorders - rehabilitation Family medical history Female Functional Independence Measure Humans Inpatients Male Medical sciences Middle Aged Multiple sclerosis Multiple Sclerosis - rehabilitation Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Neurology Neurology - instrumentation Outcome Assessment, Health Care Patients Quality of life Rehabilitation responsiveness Stroke Studies Validity Human Nervous system diseases Multiple sclerosis Central nervous system disease Exploration Rehabilitation Comparative study Inflammatory disease
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Summary:	BACKGROUND The importance of evaluating disability outcome measures is well recognised. The Functional Independence Measure (FIM) was developed to be a more comprehensive and “sensitive” measure of disability than the Barthel Index (BI). Although the FIM is widely used and has been shown to be reliable and valid, there is limited information about its responsiveness, particularly in comparison with the BI. This study compares the appropriateness and responsiveness of these two disability measures in patients with multiple sclerosis and stroke. METHODS Patients with multiple sclerosis (n=201) and poststroke (n=82) patients undergoing inpatient neurorehabilitation were studied. Admission and discharge scores were generated for the BI and the three scales of the FIM (total, motor, and cognitive). Appropriateness of the measures to the study samples was determined by examining score distributions, floor and ceiling effects. Responsiveness was determined using an effect size calculation. RESULTS The BI, FIM total, and FIM motor scales show good variability and have small floor and ceiling effects in the study samples. The FIM cognitive scale showed a notable ceiling effect in patients with multiple sclerosis. Comparable effect sizes were found for the BI, and two FIM scales (total and motor) in both patients with multiple sclerosis and stroke patients. CONCLUSION All measures were appropriate to the study sample. The FIM cognitive scale, however, has limited usefulness as an outcome measure in progressive multiple sclerosis. The BI, FIM total, and FIM motor scales show similar responsiveness, suggesting that both the FIM total and FIM motor scales have no advantage over the BI in evaluating change.
Bibliography:	local:jnnp;66/4/480 istex:BF40E5B024099666FA79CE0BABA23EDF00BD4C6F href:jnnp-66-480.pdf PMID:10201420 ark:/67375/NVC-BSKQ2ZLX-3 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0022-3050 1468-330X
DOI:	10.1136/jnnp.66.4.480