Inter-rater agreement and stability of functional assessment in the community-based elderly

Ottenbacher, Kenneth J.; Mann, William C.; Granger, Carl V.; Tomita, Machiko; Hurren, Dianne; Charvat, Barbara

doi:10.1016/0003-9993(94)90276-3

Cited by 102 publications

(42 citation statements)

References 11 publications

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“…The sociodemographic information in the UDS MR database is obtained from medical records, performance‐based observation, and self reports. Although the consistency of the information collection process has been examined (10, 11), the possibility of coding and reporting errors exists. Another limitation is the lack of information regarding acute‐care hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…The FIM Instrument was administered within 72 hours of inpatient rehabilitation admission and discharge. Followup data were collected by telephone interview 80–180 days after discharge by nurses trained in administering and interpreting the FIM Instrument (10, 11). Independent researchers have confirmed the reliability and validity of the data collection process (12, 13).…”

Section: Methodsmentioning

confidence: 99%

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Impact of osteoarthritis on the rehabilitation of patients following a stroke

Nguyen-Oghalai¹,

Ottenbacher²,

Granger³

et al. 2005

Arthritis Rheum

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Objective. To determine if functional gain for patients following stroke rehabilitation is adversely affected by osteoarthritis (OA). Methods. A retrospective cohort analysis was conducted using data collected between 1994 and 2001 from a large national registry of US rehabilitation inpatients. Outcome variables were functional status (the Functional Independence Measure [FIM Instrument]) at discharge and followup, FIM gain during and after rehabilitation, length of stay, and discharge setting. The primary predictor variable was the presence of OA. Covariates were age, sex, race, other comorbidities, type of stroke, length of stay, and time to followup. Analysis was by multivariable regression. Results. Data from 3,094 patients with OA and 44,943 patients without OA admitted following a stroke to inpatient rehabilitation facilities were analyzed. In unadjusted analyses, OA was associated with significantly higher FIM ratings than patients without OA at admission (mean ؎ SD 65.7 ؎ 19.2 versus 63.1 ؎ 20.5; P < 0.001) and discharge (mean ؎ SD 89.2 ؎ 21.8 versus 87.7 ؎ 23.0; P < 0.001), but with lower FIM ratings at followup (mean ؎ SD 97.7 ؎ 24.7 versus 99.7 ؎ 24.9; P < 0.001). In multivariate analyses, adjusting for potential confounders, OA was associated with a 1.62-day increase in length of stay (95% confidence interval [95% CI] 1.15, 2.08) and a 1.37 smaller improvement in FIM scores between admission and followup (95% CI 0.62, 2.12). This smaller increase in FIM instrument score was caused by less improvement in FIM after discharge. Conclusion. OA impairs recovery from stroke. This is compensated for by longer length of stay for inpatient medical rehabilitation. Reimbursement systems may need to consider the impact of OA as a comorbid condition in patients receiving stroke rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of osteoarthritis on the rehabilitation of patients following a stroke

Nguyen-Oghalai¹,

Ottenbacher²,

Granger³

et al. 2005

Arthritis Rheum

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“…However, these codes do not provide information on disease severity, including previous joint deformities (14, 20). Also, errors in coding and reporting errors are possible (6, 8, 10). These errors should be nondifferentially distributed, and can lead to underestimation of the differences between groups (21).…”

Section: Discussionmentioning

confidence: 99%

“…Total FIM ratings can range from a minimum of 18, reflecting total dependence, to a maximum of 126, reflecting total independence. The interrater reliability and stability of the FIM information collected at discharge and followup ranges from 0.79 to 0.99 based on intraclass correlation (8–10).…”

Section: Methodsmentioning

confidence: 99%

Functional outcome after stroke in patients with rheumatoid arthritis and systemic lupus erythematosus

Nguyen-Oghalai¹,

Wu²,

McNearney³

et al. 2008

Arthritis & Rheumatism

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Objective. To compare outcomes following stroke rehabilitation among patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) versus patients with neither RA nor SLE (non-RA/SLE). Methods. We conducted a retrospective analysis using a national database of patients with stroke admitted to inpatient rehabilitation between 1994 and 2001. Primary outcomes were discharge disposition and functional status, rated by the Functional Independence Measure (FIM) Instrument, at discharge and at followup. The independent variable was RA or SLE. Covariates were age, sex, race/ethnicity, admission FIM ratings, additional comorbidities (none, 1-3, and >3), type of stroke, and length of stay. Results. We studied 47,853 patients with stroke, 368 with RA, and 119 with SLE. Discharge dispositions were similar for patients with RA and non-RA/SLE (81% discharged home). At discharge, the average FIM rating for patients with RA was 85.8, compared with 87.8 for non-RA/SLE patients. At followup, the average FIM rating for patients with RA was 95.9, compared with 99.6 for non-RA/SLE patients. RA was associated with lower FIM ratings at discharge and followup in multivariate analyses. SLE was associated with younger age (17.5 years). However, patients with SLE had similar discharge dispositions and FIM ratings to non-RA/SLE patients. Conclusion. RA was associated with lower functional status ratings at discharge and followup. Outpatient therapy for patients with RA may reduce long-term assistance. Patients with SLE were younger, but had similar functional outcomes to patients without RA/SLE, suggesting early morbidity from stroke among patients with SLE.

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“…The inter-rater reliability of fully credentialed subscriber facilities is reported as ICC = 0.96 for total FIM scores with kappa values from 0.66 to 0.83 for individual items. Several studies have been conducted to examine and support the reliability and validity of the FIM (Hamilton et al, 1994;Ottenbacher et al, 1994). The FIM instrument was administered within 3 days of admission.…”

Section: Fimmentioning

confidence: 99%

Unilateral and bilateral upper extremity weight‐bearing effect on upper extremity impairment and functional performance after brain injury

Reistetter

Abreu

Bear‐Lehman

et al. 2009

Occupation Therapy Intl

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The purpose of the study was to investigate the effect of upper extremity (UE) weight bearing on UE impairment functional performance of persons with acquired brain injury (BI). A quasi-experimental design was used to examine a convenience sample of 99 persons with acquired BI and 22 without BI (WBI) living in a community re-entry centre. A computerized force-sensing array pressure map system was used to determine the UE pressure during unilateral and bilateral conditions. Differences between groups were examined using t-tests. Correlations were computed between UE weight bearing and hand function, and functional performance as measured by the Fugl-Meyer scale and functional independence measure (FIM) scale. The group of people with BI exerted significantly lower UE weight bearing during unilateral conditions as compared with persons WBI [left: t (119) = 2.34, p = 0.021; right: t (119) = 4.79, p = 0.043). UE weight-bearing measures correlated strongly with FIM motor scores with bilateral UE conditions yielded the highest significant correlation (bilateral left r = 0.487, p < 0.001; bilateral right r = 0.469, p < 0.01). The results indicated that UE weight-bearing pressure differs in unilateral and bilateral conditions, between persons with and WBI and between persons with stroke and traumatic brain injury. These findings may have implications for occupational therapists that use unilateral versus bilateral motor training for rehabilitation. There is a need to replicate the study design with a randomized and stratified sample of persons with BI.

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Inter-rater agreement and stability of functional assessment in the community-based elderly

Cited by 102 publications

References 11 publications

Impact of osteoarthritis on the rehabilitation of patients following a stroke

Impact of osteoarthritis on the rehabilitation of patients following a stroke

Functional outcome after stroke in patients with rheumatoid arthritis and systemic lupus erythematosus

Unilateral and bilateral upper extremity weight‐bearing effect on upper extremity impairment and functional performance after brain injury

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