A functional strategy for classifying patients after traumatic spinal cord injury

Abstract

Objectives: To present a function-based strategy for classifying patients by expected functional outcomes measured as patients' performances at discharge on each of the 18 component items of the FIM 2 instrument (previously known as the Functional Independence Measure). Methods: Data included records from 3604 inpatients with traumatic spinal cord injury discharged from 358 rehabilitation units or hospitals in 1995. The function-based strategy assigned patients to four Discharge Motor-FIM-Function Related Groups de®ned by patients' admission performance on the motor-FIM items. Results: The majority of patients whose motor-FIM scores at admission were above 30 were able to groom, dress the upper body, manage bladder function, use a wheelchair, and transfer from bed to chair, either independently or with supervision, by the time of discharge from inpatient rehabilitation. Most patients whose scores were above 52 attained independence in all but the most di cult FIM tasks, such as bathing, tub transfers, and stair climbing. Conclusions: This classi®cation scheme can be used to determine the degree to which patients' actual FIM outcomes compare to other individuals who had similar levels of disabilities at the time of admission to rehabilitation. The clinician can apply these`FIM item attainment benchmarks' retrospectively in quality improvement, in guideline development, and in anticipating the types of post-discharge care required by clinically similar groups.

United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III)

“…4 The FIM is known to be a measure of burden of care rather than functional recovery for the SCI population 1 and floor/ceiling effects have been described. 5,6 A recent study evaluating the sensitivity of the SCIM III to measure functional change noted some floor/ceiling effects dependent upon injury level, in particular, with the respiration task and some mobility tasks. 7 Perhaps the results and recommendations from that study and the current study can be used to improve the SCIM to the point of becoming the new standard for measuring functional recovery.…”

Properties and outcomes of spinal rehabilitation units in four countries

“…Variation in outcomes has been related to injury severity, degree of disability at admission, age, other demographic variables and various complications. [1][2][3][4] The outcome measure most widely used to assess neurological recovery during SCL rehabilitation is the change in the American Spinal Injury Association (ASIA) impairment scale (AIS). 5 Outcome measures that have been used to assess the clinical effectiveness of rehabilitation in SCL patients include improvement in daily functioning during rehabilitation, represented by gain (discharge minus admission value) in functional independence measure (FIM) or spinal cord independence measure (SCIM) scores.…”

Can Administrative Claim File Review Be Used to Gather Physical Therapy, Occupational Therapy, and Psychology Payment Data and Functional Independence Measure Scores? Implications for Rehabilitation Providers in the Private Health Sector

“…The FIM, which assesses disability and caregiver burden associated with disability, is widely used as a functional assessment measure for SCI, including outpatient SCI rehabilitation research. 16,[51][52][53][54] At the time the e-claim files used in our study were compiled by WSIB, the FIM was routinely captured at time of discharge from publicly funded acute care and rehabilitation institutions; 55 therefore, we anticipated that if the health record included a functional measure, it would most likely be the FIM. For these reasons, the FIM may be considered a surrogate measure for functional status for the purpose of examining SCI rehabilitation outcomes.…”