Rehabilitation impact indices and their independent predictors: a systematic review

Abstract

ObjectivesTo (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs.DesignSystematic review.Data sourcesPubMed and references in primary articles.Study selectionFirst, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case–control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed.ResultsThe five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy.Conclusions5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.

Self-rehabilitation with a game

“…The demographic questionnaire collected important control variables whose fulfillment or higher values the literature has associated with decreases of patients' rehabilitation impact indices [24], which were our dependent variables. These control variables included: age, trial duration (LoT) and in the clinic (LoS), cognitive impairment (FIM C ), time delay from lesion onset to rehabilitation unit admission (admission delay), gender (female), and USN.…”

Methods for Improving the Predictive Accuracy Using Multiple Linear Regression Analysis to Predict the Improvement Degree of Functional Independence Measure for Stroke Patients

“…The FIM effectiveness is defined as FIM gain/(126 points-FIM scores at admission), while the mFIM effectiveness is defined as mFIM gain/(91 points-mFIM scores at admission) [19]. The denominator in the definition here is the maximum possible improvement in FIM score for a given patient, while the numerator is the actual improvement in FIM score; thus the FIM effectiveness is a value between 0 and 1 which measures the improvement actually achieved as a fraction of the maximum potential improvement possible [19,20].…”

“…The FIM effectiveness is defined as FIM gain/(126 points-FIM scores at admission), while the mFIM effectiveness is defined as mFIM gain/(91 points-mFIM scores at admission) [19]. The denominator in the definition here is the maximum possible improvement in FIM score for a given patient, while the numerator is the actual improvement in FIM score; thus the FIM effectiveness is a value between 0 and 1 which measures the improvement actually achieved as a fraction of the maximum potential improvement possible [19,20]. Among "studies investigating the influence of various factors on ADL improvement, " FIM effectiveness has been used more frequently than FIM gain or FIM efficiency (63 studies using ADL effectiveness, compared to 7 studies using ADL gain and 16 studies using ADL efficiency) [19].…”

Inflammatory Biomarker and Stroke Rehabilitation a New Point of View about the Role in Prognostic Factor

“…Recent studies have shown that T-cells also have an impact on tissue damage [12][13][14][15][16][17][18][19][20]. Several studies have seen that an attenuation of the inflammatory process could be a possible way to widen the therapeutic window after the acute event [8,11,12].…”

“…Total scores range from 18 to 126 and indicate to what extent an individual is capable to reach independence in ADL. In our study we used the FIM effectiveness, calculated as (FIM at discharge-FIM on admission)/(126-FIM on admission) according to Koh and colleagues [20]. FIM effectiveness, which is independent from FIM on admission, has been used to compare patients with various degrees of disability severity.…”