Psychometric Properties of the Functional Independence Measure (FIM) in Iranian Patients With Traumatic Brain Injury

Abstract

Background: The functional independence measure (FIM) is a practical tool for the evaluation of motor and cognitive independence, which has been validated in different languages; its Persian version has not been studied so far. Objectives: In this cross-sectional study, the validity, reliability, and replicability of FIM for Iranian patients with traumatic brain injuries (TBIs) were determined. Patients and Methods: Forty patients with acute TBI that were hospitalized in emergency ward for evaluation of inter-rater reliability for the test replicability and 185 sub-acute TBI patients that were in the neurosurgery ward of Poursina educational hospital in Rasht were selected in the assessment of other psychometric indices by the consecutive sampling method. The tests used include the FIM for measuring motor and cognitive functioning, the Barthel Index for measuring physical disability, the mini mental state examination (MMSE), and questions on the physical dimension of quality of life in the short form health survey (SF-36) were used. Statistical analyses were performed using Intraclass correlation coefficient (ICC), Cronbach's Alpha and Pearson correlation coefficients, independent t-tests, and hierarchical regression analyses. Results: The inter-rater reliability was acceptable on admission and at discharge (ICC = 0.779 to 0.895). The internal consistency of FIM and its subscales were excellent (α ≥ 0.97). The results for criterion validity by adjusting the values of GCS on admission and at discharge showed that the FIM motor dimension could predict a significant proportion of the variance of Barthel index scores; and the physical health components of quality of life and overall physical component of SF-36 (PCS) and FIM cognitive dimension could predict a significant proportion of the variance of MMSE scores (all P < 0.05). FIM and its subscales were correlated with the above variables in expected directions (all P < 0.01). In known-groups validity, patients with physical trauma and cognitive impairment obtained lower motor (t = 2.09, P = 0.038) and cognitive (t = 3.36, P < 0.0001) FIM scores compared to the groups with no physical trauma or cognitive impairment. Conclusions: This Persian version of the FIM can be used as a valid, reliable, and replicable instrument for research and rehabilitation purposes in TBI patients.

Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study

“…The finding of lower motor functional independence trajectories in the foreign-born group compared with those born in the United States parallels literature showing ethnically diverse groups to have lower motor independence than Whites with TBI. 19 Upward quadratic trajectory in motor functional independence, with the greatest gains between the 5-and 10-year time points, also parallels previous literature showing greater motor independence over time. 20 To date, no studies have explored how cultural practices impact motor independence among foreign-born individuals with TBI.…”

Effects of Vestibular Rehabilitation on Fatigue and Activities of Daily Living in People with Parkinson’s Disease: A Pilot Randomized Controlled Trial Study

“…This questionnaire contains 18 items (13 items related to motor skills and 5 items related to the cognitive one). Each item has 7 ratings in which 7 means complete independence in activities and 1 means complete dependence, requiring maximum help in performing daily activities [ 24 , 25 ].…”

Validity and Reliability of the Short Form Health Survey Questionnaire (SF-36) for Use in Iranian Patients With Traumatic Brain Injury (TBI)

“…Short Form Health Survey Questionnaire (SF-36): The questionnaire was designed by Ware et al to assess the quality of life. It has 36 questions with two general performance measures (see appendix), namely the Physical Component Summary (PCS), which examines the physical dimension of health, and the Mental Component Summary (MCS) which also measures the psychosocial aspect of health [15,22]. It should be noted that the second item of this questionnaire is not calculated in any of the subscales.…”

“…For years, the SF-36 has been a common questionnaire to assess the Health-Related Quality of Life (HRQoL) among different populations and has been translated into Persian, and its psychometric properties have been evaluated in Iran. Also, it has been utilized in studies on TBI in Iran; however, there is no study on the evaluation of psychometric properties of the Persian version of SF-36 in the TBI patient population [12][13][14][15].…”