Comparing the Functional Independence Measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature

Abstract

BackgroundThe rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.MethodsEnglish language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.ResultsIn total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.ConclusionAdditional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.

Pre- and Postintervention Factor Structure of Functional Independence Measure in Patients with Spinal Cord Injury

“…Instead, three different factors were observed. This kind of multidimensionality has been reported before in elderly people with multiple causes of disability [28], but this phenomenon has not been described earlier amongst people with SCI.…”

Association between body mass index and cause‐specific mortality as well as hospitalization in frail Chinese older adults

“…Data retrieved from the medical records of the older adults at discharge from the GDH included demographic data, medical status, functional status, cognitive status, social status and serum albumin. [20][21][22] The functional independence measure has a total of 18 items divided into six major subgroups: self-care ability (eating, grooming, bathing, dressing upper body, dressing lower body, toileting), sphincter control (bladder control and bowel control), transfer (bed/chair transfer, toilet transfer, bathtub transfer), locomotion (walking on level ground, stair use), communication (comprehension and expression) and social/cognition (social interaction, problem-solving, memory). For medical status, the number and the type of comorbidities were quantified using the Charlson Comorbidity Index, which is a valid and reliable method to measure comorbidity.…”

Scheduled Analgesic Regimen Improves Rehabilitation After Hip Fracture Surgery

“…The tool had adequate consistency in various elderly populations and concurrent validity with other functional measures [13, 21, 68]. We assumed that the standard deviation of the Functional Independence Measure™ was approximately 15.…”