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Evaluation of a 5-level functional independence measure in a longitudinal study of elderly stroke survivors.

Journal article
Authors Gunilla Gosman-Hedström
Christian Blomstrand
Published in Disability and rehabilitation
Volume 26
Issue 7
Pages 410-8
ISSN 0963-8288
Publication year 2004
Published at Institute of Occupational Therapy and Physiotherapy
Institute of Clinical Neurosciences
Pages 410-8
Language en
Keywords Activities of Daily Living, Aged, Aged, 80 and over, Cerebrovascular Accident, rehabilitation, Health Status Indicators, Humans
Subject categories Neurology, Occupational Therapy, Older people and ageing


PURPOSE: The aim of the present study was to evaluate a modified 5-level Functional Independence Measure (FIM), by using the assessments from a longitudinal study of elderly stroke survivors. METHOD: One hundred and seventy-three patients were followed longitudinally. Firstly, the 7-level FIM was used at 0-3 days, 3 weeks, and 3 months and then after 1 year following acute stroke. The data, in total 8996 assessments, were presented on the item level. Secondly, the data were recoded with the help of a modified 5-level FIM according to the cut-off levels suggested in a previous study of the same target group. Two registered occupational therapists did the assessments in the patients' natural environment, i.e., in their own homes or in different kinds of assisted living. The data were obtained both by interviews and with the help observations, when the occupational therapist asked the patients to perform specific activities. RESULTS: The assessments on all four occasions were found to polarise when using the 7-level FIM, and the intermediate levels of assistance were more seldom used. After the assessment data were recoded with the modified 5-level FIM, it was shown that it was easier to follow the process of activity by using an instrument with fewer levels. A modified 5-level FIM had enough levels to ensure sensitivity and was easier to handle when evaluating performance of daily activities in a large population study. CONCLUSIONS: A modified 5-level FIM can be useful in large population studies and most likely increase reliability without losing in sensitivity.

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