Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury

Abstract

Study design: Repeated-measures design. Objectives: To assess the validity and responsiveness of five additional mobility and locomotor (5-AML) items when used in conjunction with the Functional Independence Measure (FIM) for assessing the mobility and locomotor function of individuals with spinal cord injury (SCI). Setting: Specialised acute spinal and rehabilitation units in Sydney, Australia. Methods: A previously published scale comprising five key mobility and locomotor skills was further refined. The five items included a bed mobility and vertical (floor-to-chair) transfer item and three wheelchair propulsion items (pushing 200 m over flat ground, pushing up a ramp and negotiating a kerb). A total of 43 eligible patients with SCI (ASIA A-C impairment) admitted consecutively to two acute SCI units in Sydney between 1999 and 2002 were recruited, with four being lost to follow-up. Locomotor and mobility outcomes were measured at regular intervals for up to 6 months with the FIM and the 5-AML. Construct validity of the 5-AML was assessed by testing ability of items to discriminate between different impairment groups (tetraplegia and paraplegia). Item responsiveness was assessed by analysing ability to detect changes in mobility and locomotor function over time. Factor analysis techniques were used to test the hypothesis that the 5-AML, when used in conjunction with the FIM, provides a more sensitive measure of mobility and locomotor function than the FIM alone. Results: The 5-AML items were shown to be valid and responsive, measuring aspects of 'real world' mobility and locomotor function not reflected by the FIM. The bed mobility item was highly responsive to change over time for the tetraplegic group, but quickly reached a ceiling in the paraplegic group. The vertical (floor-to-chair) transfer item showed greater responsiveness over time and less ceiling effect for the paraplegic group than any of the FIM locomotor or mobility items. The three wheelchair propulsion items better discriminated between people with tetraplegia and paraplegia, and were more sensitive to changes in locomotor ability over the 6-month period than FIM locomotor items. Results of a preliminary factor analysis indicated that the 5-AML items measure different aspects of mobility and locomotor function than the FIM. Conclusion: The 5-AML items, when used in conjunction with the FIM, provides better delineation of function between people with tetraplegia and paraplegia and provides a more responsive measure of change in function over time than the FIM alone.

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

“…Factors such as time of injury, criteria used to classify the injury, type of patient care (outpatient or inpatient rehabilitation) and time of evaluation for the responsiveness may be important in comparing results from other studies, such as Riberto et al 5 Our study differs to the results of Middleton et al, 11,19 who showed poor validity and responsiveness to mobility and locomotion items. This difference is possible because patients with AIS D were excluded in the Australian studies, which had a small sample size.…”

“…The discrepancies observed in comparison with other studies may be due to differences in the stratification of the sample taken in the studies ranging between two groups (paraplegics and tetraplegics), 19 three groups (cervical, thoracic and lumbar) and more than four groups based on key muscles 3,11 or completeness of injury. 10 Dodds et al 10 examined 777 spinal cord injury subjects assessed by Uniform Data System and reported significant differences in FIM scores between different levels of impairment severity.…”

“…4,5,11,19 In this study, the difference may be because 63% of subjects had incomplete spinal cord injury (AIS D) or conus medulares/cauda equina syndrome and used the walking as a form of locomotion and were therefore independent up and down the stairs.…”

“…This difference is possible because patients with AIS D were excluded in the Australian studies, which had a small sample size. In the study by Middleton et al 11,19 , subjects were assessed in manual rather than motorized wheelchair. However, FIM states that the patients should be assessed in their most common mode of locomotion.…”

Análise dos valores de composição corporal em homens com diferentes níveis de lesão medular

“…Thus, some studies categorize the spinal cord injury levels into groups, so that more systematized comparisons can be carried out (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Usually, the divisions are characterized as quadriplegia, due to impairment of the upper limbs, high paraplegia, due to changes in the autonomic nervous system and muscles of the abdominal circumference, and low paraplegia.…”