ADL STRUCTURE FOR NONDISABLED JAPANESE CHILDREN BASED ON THE FUNCTIONAL INDEPENDENCE MEASURE FOR CHILDREN (WeeFIM™)1

Abstract

The Functional Independence Measure for Children (WeeFIM) instrument was developed, based on the FIM instrument, to assess disability in children aged 6 mo to 7 yr. Normative data are reported for American and Japanese children, and it is increasingly used for the disabled. Our purpose was to confirm scale quality and to determine the difficulty pattern of the WeeFIM in Japan. The WeeFIM was measured in 225 children (113 girls and 112 boys) aged 6 mo to 7 yr without developmental delays. The scores were converted to an interval scale by Rasch analysis, which assumes unidimensionality of the measurement items, determines the degree of the fit to the assumption, and decides item difficulty. When the WeeFIM items were divided into two groups of motor and cognitive items to minimize misfit, the degree of misfit was acceptable, except for eating, bladder management, tub/shower transfer, and comprehension. For the motor items, grooming, bathing, and bladder control were more difficult, and stairs, bed/chair transfer, and walk or wheelchair were easier. Concerning the cognitive items, expression and comprehension were easier, and problem-solving was most difficult. When we compared item difficulty patterns in the four age groups (6-21 mo, 22-45 mo, 46-62 mo, and 63-100 mo), we found no differences, except in toilet transfer. It was more difficult for younger children, possibly because of its different pattern of chronological change, which shows rapid changes from dependent to independent levels over a short period of time. Our study confirmed the scale quality of the WeeFIM instrument with Rasch analysis and demonstrated the difficulty pattern of the WeeFIM in nondisabled Japanese children.

Measuring functional skills in preschool children at risk for neurodevelopmental disabilities

“…The WeeFIM has been used in the longitudinal study of developmental, health, and functional outcomes in children with severe congenital heart disease [Limperopoulus et al, 2001], in children with spinal muscle atrophy [Chung et al, 2004], in children with retinopathy of prematurity , in girls with severe disabilities as a result of Rett's Syndrome [Colvin et al, 2003], and in survivors of shaken baby-inflicted head trauma. It has been translated into Japanese, Chinese, and Thai with both norms generated for children in good health and without disability and application to children with disability using appropriate developmental assessments [Tsuji et al, 1999;Jongjit et al, 2002;Wong et al, 2002]. Because the WeeFIM items include several components of an activity, the test rating does not reflect partial success in particular skills.…”

Measuring functional outcomes after prematurity: Developmental impact of very low birth weight and extremely low birth weight status on childhood disability

“…The WeeFIM has demonstrated responsiveness to change in children with cerebral palsy in early intervention, children ages 1-7 years with motor, communicative, developmental, or genetic impairments in early childhood programs and in children ages 7-16 years receiving orthopedic interventions for cerebral palsy McAuliffe et al, 1998;Azuala et al, 2000;Ottenbacher et al, 2000;Msall et al, 2001]. The WeeFIM has been used as part of outcomes assessment in surfactant clinical trials, after cryosurgery for retinopathy of prematurity, in children with congenital heart disease, in children with genetic disabilities, in children with traumatic injury, and in Chinese and Japanese children [Msall et al, 1993b;Liu et al, 1998;Tsuji et al, 1999;Msall and Tremont, 2000;Limperopoulous et al, 2001;Aitkin et al, 2002;Wong et al, 2002]. The WeeFIM takes approximately 20 minutes to administer.…”

Psychometric Properties and Developmental Differences in Children’s ADL Item Hierarchy

“…In the case of locomotion and transfers, children were dependent as infants and toddlers but achieved independence around 3 yrs of age, and young children achieved independence in walking before eating, upper and lower body dressing, bathing, and grooming. In a subsequent article, Tsuji et al 17 used Rasch rating scale analysis (RSA) to examine WeeFIM motor and cognitive item difficulty. They concluded that walking, bed/chair transfer, stair climbing, and eating were the easiest items, whereas grooming and bathing were the hardest items for Japanese children without disabilities.…”