Cross-cultural validity of FIM in spinal cord injury

Abstract

Objective: To analyse cross-culture validity of the Functional Independence Measure (FIMt) in patients with a spinal cord injury using a modern psychometric approach. Settings: A total of 19 rehabilitation facilities from four countries in Europe. Participants: A total of 647 patients at admission, median age 46 years, 69% male. Methods: Data from the FIMt, collected on inpatient admission, was fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIMt items was undertaken before to testing fit to the model. Categories were rescored where necessary. Fit to the model was assessed initially within country, and then in the pooled data. Analysis of differential item functioning (DIF) was undertaken in the pooled data for each of the FIMt motor and social cognitive scales, respectively. Final fit to the model was tested for breach of local independence by principle components analysis (PCA). Results: The present scoring system for the FIMt motor and cognitive scales, that is a seven category scale, was found to be invalid, necessitating extensive rescoring. Following this, DIF was found in a number of items within the motor scale, requiring a complex solution of splitting items by country to allow for the valid pooling of data. Five country-specific items could not be retained within this solution. The FIM cognitive scale fitted the Rasch model after rescoring, but there was a substantial ceiling effect. Conclusions: Data from the FIMt motor scale for patients with spinal cord injury should not be pooled in its raw form, or compared from country to country. Only after fit to the Rasch model and necessary adjustments could such a comparison be made, but with a loss of clinical important items. The FIM cognitive scale works well following rescoring, and data may be pooled, but many patients were at the maximum score.

The experience of using the scale of Functional Independence Measure in individuals undergoing spinal cord injury rehabilitation in Brazil

“…4 To improve the 'mobility' and 'locomotion' subscales, some authors have proposed to add more items that better assess these specific disabilities or create separete subscales. 10,19 The findings reinforce the theory by Lawton et al, 13 which points out the different socio-cultural factors as determinants of functional independence, reaffirming the need to evaluate the psychometric properties of each instrument in different contexts.…”

“…11 In Brazil, Riberto et al 5 found good validity and responsiveness of FIM in outpatients with cervical, thoracic and lumbar spinal cord injuries. 5 Lawton et al 13 demonstrated the need for a continuous process of evaluation of psychometric characteristics that are influenced by patient difficulty in performing tasks, which can vary between populations, by training as well as differences in the translations and different versions used.…”

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury

“…45 Evidence of construct validity could appear inconsistent or contradictory in some instances. Thus, Rasch analysis revealed problems concerning disordered thresholds (grooming and stairs items) and model misfit affecting bladder and bowel items in the FIM motor domain 29,23 (bladder and bowel items in the MBI Turkish version were also associated with considerable levels of misfit in Rasch analysis 19 ), that appeared to be accentuated in cross-cultural comparisons; 22 whereas evidence from factor analysis, produced an unproblematic two-factor solution (together using all 18 items), with each scale further associated with a high level of internal consistency (itself a form of convergent validity). 26 Findings from Rasch analysis highlighted some flaws relating to construct validity for the SCIM version III, with 'walking outdoors' and 'stair management' items within the mobility subscale, and 'toilet use' within the respiration/ sphincter subscale exhibiting misfit.…”

“…In contrast with the BI and MBI, the original FIM has been assessed in a number of studies with SCI patients 48,[21][22][23] , as have the more recent adapted versions 29,27,28,49 of the FIM. The SIP68 has also been evaluated with SCI patients in two studies with relatively large sample sizes.…”

Traumatic and Non-Traumatic Spinal Cord-Injured Patients in Quebec, Canada: 1. Epidemiological, Clinical and Functional Characteristics

“…In contrast, higher risks of NTSCI were reported in older adults with a more or less even male to female ratio [5,6]. Given that several SCIrelated characteristics are increasingly believed to depend upon social-related factors [7][8][9], it may be critical for proper comparisons between TSCI and NTSCI people to study these characteristics in a rather homogenous and thus comparable (e.g., geographically, socio-politically, and culturally) cohort of patients. Consequently, the main aim of this study was to assess and compare in the relatively homogenous community of Trois-Rivieres City, clinical, functional, and epidemiological characteristics of TSCI and NTSCI patients.…”