Background: The rehabilitation of older persons is often complicated by increased frailty and medical complexity – these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings – in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems and performed a direct empirical comparison of the operating characteristics and validity of the FIM motor and the ADL items on the PAC in a sample of older adults receiving rehabilitation. Methods: For the first objective english language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements. For the second objective we used Rasch analysis and responsiveness statistics to investigate and compare the instruments dimensionality, item difficulty, item fit, differential item function, number of response options and ability to detect clinically relevant change. Results: The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS. The analysis showed that the FIM may be slightly more responsive than the PAC, especially in the MSK patients. However, both scales had similar limitations with regards the large ceiling effect and many unnecessary response options. Conclusions: Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and ability to discriminate between subjects with functional higher ability.

Background: The rehabilitation of older persons is often complicated by increased frailty and medical complexity – these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings – in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems and performed a direct empirical comparison of the operating characteristics and validity of the FIM motor and the ADL items on the PAC in a sample of older adults receiving rehabilitation. Methods: For the first objective english language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements. For the second objective we used Rasch analysis and responsiveness statistics to investigate and compare the instruments dimensionality, item difficulty, item fit, differential item function, number of response options and ability to detect clinically relevant change. Results: The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS. The analysis showed that the FIM may be slightly more responsive than the PAC, especially in the MSK patients. However, both scales had similar limitations with regards the large ceiling effect and many unnecessary response options. Conclusions: Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and ability to discriminate between subjects with functional higher ability.

The numbers of people with spinal cord injuries (SCI) in Thailand are increasing. Thai rehabilitation care focuses treatment on acute care with little attention to the lives of clients after discharge from institutions. To date, there has been no research on rehabilitation outcomes and factors relevant to these issues for people with SCI at home and in the community in Thailand. The purpose of this study was to identify and compare the outcomes of functional status, depression, anxiety and stress, and health status of people with SCI, both at discharge and at three months post-discharge from hospital. One hundred twenty-one participants with SCI were recruited from ten major hospitals in Thailand. Data was collected at 48 hours pre-discharge and again at three months post-discharge using the Functional Independence Measure (FIM), the Depression, Anxiety, and Stress Scale (DASS), and the SF-36 Health Survey. The results demonstrated that mean scores of functional status at discharge were significantly higher than at three months post-discharge. Depression and anxiety scores at discharge were significantly lower than depression and anxiety scores at three months postdischarge. Stress score had not significantly changed from discharge to post-discharge. Health status scores at discharge were also higher than at three months post-discharge on eight subscales. Factors relevant to or predicting functional status were marital status, attendant care, number of architectural barriers, fulfilled occupational therapy (OT) needs, and number of different services required but not received. Factors predicting depression, anxiety and stress were marital and economic status, age at onset, education level, duration of disability, fulfilled OT needs, number of different services received, and numbers of different service required but not received. / Factors predicting health status were marital status, economic status, age at onset, education level, duration of disability, attendant care, number of architectural barriers, fulfilled OT needs, number of different services received, and number of different services required but not received. Some predictive factors are culture-specific, but on others, rehabilitation professionals could ease the transition from hospital to home for people with SCI.

<p>This thesis focuses on routine outcome measurement in occupational therapy; specifically the use of the Canadian Occupational Performance Measure (COPM) in inpatient geriatric rehabilitation.</p> <p>The purpose of the first study (Chapters two and three) was to: 1) determine if routine COPM use was associated with improved functional outcome; 2) gather therapist perceptions on routine COPM use; and, 3) propose a template for summarizing COPM data. A cohort study with a therapist participant survey measured the difference in Functional Independence Measure (FIM^™) change scores between an experimental group (n = 45) that implemented the routine use of the COPM for evaluation/planning and a historical “usual care” comparison group (n = 58). Using generalized linear modeling, it was found that both groups had significant changes in FIM^™scores over time (p <. 05). Differences between groups were not significant. Therapists perceived that the COPM facilitated treatment but experienced challenges in routine use. Therapists placed more importance on individual than group data.</p> <p>The second study (Chapter four) determined if routine use of the COPM was associated with changes in five domains of practice: focus of care on occupation, knowledge of client perspective, clinical decision-making, clinician ability to articulate outcomes, and documentation. Twenty-four occupational therapists on eight geriatric rehabilitation units completed a before-and-after study with a repeated baseline. Domains of practice during three months of standard care (no COPM) were compared using Chart Stimulated Recall and chart audit as outcome measures to three months of intervention (COPM). Mean practice scores indicated a significant effect for time (p < .0001) but no effect based on the frequency of COPM use. Chart audit indicated that COPM use resulted in more occupation-focused issue identification.</p> <p>This thesis challenges assumptions regarding the value of measurement and contains the first study to demonstrate that routine outcome measure use affects occupational therapy practice.</p> / Doctor of Philosophy (PhD)

OF MASTER THESIS Author: Bc. Anna Stiborová Supervisor: Mgr. Kateřina Svěcená, Ph.D. Title of master thesis: Utilization of Functional Independence Measure and Functional Assessment Measure on acute inpatient rehabilitation unit with brain damage patients Abstract: This master thesis focuses on the utilization of Functional Independence Measure and Functional Assessment Measure (FIM+FAMUK ). The subject of interest is the use of FIM+FAMUK in an acute phase of rehabilitation in brain damaged patients. The aim of the thesis is to demonstrate the usefulness of FIM+FAMUK as an assessment of functional status on an acute inpatient rehabilitation unit. Theoretical part provides basic information on the system of cerebrovascular care in Czech republic, on the importance of assessing functional status in neurorehabilitation and on some other assessments of disability in neurorehabilitation besides FIM+FAMUK . It also brings insight into FIM+FAMUK , its items, evaluation process and its utilization. Practical part presents the results of a clinical application of FIM+FAMUK on a stroke unit. Fifteen people were assessed with FIM+FAMUK as input and output assessment. Statistical data analysis has confirmed the utilization of FIM+FAMUK as an assessment of functional status on acute inpatient rehabilitation...

Orientador: Antonio Guilherme Borges Neto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T13:43:01Z (GMT). No. of bitstreams: 1 Loureiro_AndersonBarbosa_M.pdf: 1654963 bytes, checksum: d49b2312387926f779b4d3c3fec27cfe (MD5) Previous issue date: 2007 / Resumo: A hemorragia subaracnóide (HSA) aneurismática é causada mais comumente pela ruptura de aneurismas saculares, o que leva a um déficit motor e cognitivo importante afetando as atividades funcionais dos pacientes. A mensuração da função é importante na otimização do tratamento fisioterapêutico e alta hospitalar destes pacientes. Este estudo teve como objetivo descrever os resultados da reabilitação em pacientes submetidos a tratamento cirúrgico de clipagem aneurismática admitidos no Hospital das Clínicas da Universidade Estadual de Campinas. Os pacientes foram avaliados por meio dos seguintes instrumentos: escala clínica de Hunt ¿ Hess (na internação hospitalar), que avalia o estado clínico do paciente; a escala neurorradiográfica de Fisher (na internação hospitalar), que avalia a quantidade de sangue no espaço subaracnóide; medida de independência funcional (MIF) (no pós-operatório e alta hospitalar) e escala de prognóstico de Glasgow (na alta hospitalar). Os pacientes foram submetidos ao tratamento fisioterapêutico durante todo o período de internação (dois atendimentos diários). Para comparar os valores da MIF entre admissão e alta foi realizado o teste de Wilcoxon, para verificar a correlação entre os instrumentos de avaliação foi utilizado o coeficiente de correlação de Spearman. Foram avaliados 13 pacientes, 12 (92.31%) mulheres e um homem, com predomínio de aneurismas na artéria cerebral média (53.85%). A idade média foi de 51.62 (DP 13.04) anos. Ocorreu diferença estatística significativa entre as avaliações da MIF (admissão 56.92 ± 23.42; alta 91.77 ± 20.32; p < 0.001). Não foi encontrada correlação significativa entre a MIF e a escala clínica de Hunt-Hess (r = - 0.16282; p = 0.5951), escala neurorradiografica de Fisher (r = 0.06935; p = 0.8219) e a escala de prognóstico de Glasgow (r = 0.24972; p = 0.4106). Os pacientes apresentaram melhoras funcionais após o procedimento cirúrgico e tratamento fisioterapêutico demonstradas de forma quantitativa por meio da MIF e não foi encontrada relação das medidas clínicas com os resultados funcionais / Abstract: Subarachnoid hemorrhage results in critical motor and cognitive impairment which leads to dysfunctions causing a negative impact in quality of life. The functional independence measure (FIM) scale is the most widely accepted functional assessment measure in use in the rehabilitation community. The aim of this study was to describe the rehabilitation outcome after a surgical aneurysm occlusion realized in patients admitted in the Clinical Hospital of Campinas State University ¿ UNICAMP. Patients were submitted to the Hunt-Hess and Fisher assessment scales after admission in to the hospital; to the FIM after surgery; and to FIM and Glasgow Outcome Scale (GOS) after hospital discharge. The days in the hospital were counted, patients had physical therapy twice a day and the injured arteries were identified. Thirteen patients, 12 woman¿s (92,31%) with aneurysm predominant in middle cerebral artery (53,85%) were evaluated. The mean age was 51, 62 (DP 13,04) years old. The mean FIM rate, between the admission and the discharge period, was 34,85 (DP 20,85), with average of 5-69 points (p<0,001). There was non significant correlation between the FIM, Hunt-Hess, Fisher and GOS. The subarachnoid hemorrhage is a catastrophic neurologic event that results in motor and cognitive impairment. The FIM could have an important role in predict the neurorehabilitation outcome in acute aneurysmal subarachnoid hemorrhage / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Title: Possibilities of functional Evaluation of Patients after acute cerebral Palsy in Czech Republic Objectives: The main objective of this study was to describe the problems of functional assessment of patiens after stroke. Another objektive was to determine and compare the properties ofthe most commonly used functional measures designed for stroke,in our country. Methods: This work is theoretical - research work, which is the theoretical part of the period from September 2012 to June 2013 when retrieving data from literature sources using advanced targeted keywords and thein hotkey in databases based on EBM. The practical part of the study consisted of a questionnaire, which was using the questionnaire survey gathered data needed to evaluace the clinical utility, in the period from May 2013 to July 2013. After obtaining the necessary data from both theoretical and practical part of this data was evaluated and analyzed according to the standard metodology for the evaluation of functional measures for spinal patiens (Chapman, J.R. et al, 2007) and the results of the individual measures were mutually compared. Results: In the theoretical part of the available resources found high objectivity of the free evaluated measures, the measure Barthel Index and the Functional independence measure received...

Capacidade funcional surge como novo conceito quando aborda a saúde do idoso, principalmente em se tratando de idosos com doença de Alzheimer (DA) onde o déficit cognitivo é esperado aliado ao funcional. Dessa forma as pesquisas relacionadas à capacidade funcional do idoso com DA vêm ao encontro das questões relacionadas ao cuidado desse idoso. Trata-se de um estudo observacional e transversal que teve com objetivo identificar comorbidades dos idosos com DA, mensurar nível de independência funcional, segundo a Medida da Independência Funcional (MIF), comparando com o estagiamento da demência, segundo a Avaliação Clínica da demência (Clinical Dementia Rating scale - CDR). A amostra foi constituída de 67 idosos. Os dados foram coletados em entrevistas domiciliares, utilizando-se de instrumento para identificação e perfil sociodemográfico, do Mini Exame do Estado Mental (MEEM) para avaliação do déficit cognitivo, da Medida de Independência Funcional (MIF) para avaliação da funcionalidade e, para estagiamento da demência, foi utilizada CDR. A média de idade dos idosos foi de 79 anos (+ 7,2), sendo 41,8% na faixa etária entre 75-79 anos. Houve predominio de mulheres 77,6% e viúvos 49,3%. Os idosos possuíam média de escolaridade de 5,6 anos, 73,1% tinham renda própria, 46,3% possuíam renda familiar de até 5 salários mínimos e residiam em média com 3,5 pessoas. Quanto às comorbidades existentes, 23,9 não possuíam e 53,7% tinham hipertensão arterial. O déficit cognitivo foi de 82%, e a média no MEEM de 9,3. Sobre o estagiamento da demência, 46,3% apresentavam demência grave, 22,4%% demência moderada e 31,3% demência leve. Quanto a funcionalidade, a variação dos escores observados na MIF foi igual à variação possível para MIF motora. A média geral da MIF global encontrada foi 71,1, a médias da MIF global foram 107,9; 84,5 e 39,7 para os idosos com demência leve, moderada e grave respectivamente. Os idosos com demência leve possuíam independência modificada ou necessitavam de supervisão, aqueles com demência moderada possuíam dependência mínima ou necessidade de supervisão e os idosos com demência grave eram totalmente dependentes. Foi encontrada forte correlação entre o nível de independência funcional (MIF global) com o estágio da demência e com o desempenho cognitivo (p<0,001). Não foram encontradas correlações estatisticamente significantes entre a funcionalidade e idade, sexo e presença de (co)morbidades. Concluiu-se que a capacidade funcional dos idosos com DA está relacionada ao estágio da demência, isto é, quanto mais grave a demência, maior o nível da dependência. / Functional capacity emerges as a new concept in elderly health, mainly with respect to elderly people with Alzheimers disease (AD), when a cognitive deficit is expected, connected with a functional deficit. Thus, research on functional capacity in elderly people with AD is relevant for elderly care delivery. This observational, crosssectional study aimed to identify co-morbidities of elderly people with AD, to measure the functional independence level according to the Functional Independence Measure (FIM), in comparison with the dementia staging according to the Clinical Dementia Rating scale (CDR). The sample consisted of 67 elderly. Data were collected during interviews at the elderlys home, using an identification and sociodemographic profile instrument, the Mini-Mental State Examination (MMSE) to assess cognitive deficit; the Functional Independence Measure (FIM) for functional assessment, and CDR to asses dementia staging. The mean age was 79 years (+ 7.2), with 41.8% between 75 and 79 years old. Women 77.6% and widowed people 49.3% were predominant. The elderlys mean education level was 5.6 years, 73.1% gained their own income, 46.3% gained a family income of up to 5 minimum wages and lived with an average of 3.5 people. As to existing co-morbidities, 23.9 had none and 53.7% had arterial hypertension. The cognitive deficit was 82% and the mean MMSE score 9.3. In dementia staging, 46.3% presented severe, 22.4%% moderate and 31.3% light dementia. With respect to functionality, the variation in FIM scores was equal to the possible variation for motor FIM. The mean global general FIM score was 71.1, the mean global FIM scores were 107.9 for light; 84.5 for moderate and 39.7 for severe dementia. Elderly with light dementia displayed modified independence or needed supervision; those with moderate dementia showed minimal dependence or supervision and elderly with severe dementia were fully dependent. A strong correlation was found between the functional independence level (global FIM) and dementia stage and with cognitive performance (p<0.001). No statistically significant correlations were found between functionality and age, gender and presence of co-morbidities. It was concluded that the functional capacity of elderly people with AD is related with the stage of dementia, that is, the more severe the dementia, the higher the level of dependence will be.

Capacidade funcional surge como novo conceito quando aborda a saúde do idoso, principalmente em se tratando de idosos com doença de Alzheimer (DA) onde o déficit cognitivo é esperado aliado ao funcional. Dessa forma as pesquisas relacionadas à capacidade funcional do idoso com DA vêm ao encontro das questões relacionadas ao cuidado desse idoso. Trata-se de um estudo observacional e transversal que teve com objetivo identificar comorbidades dos idosos com DA, mensurar nível de independência funcional, segundo a Medida da Independência Funcional (MIF), comparando com o estagiamento da demência, segundo a Avaliação Clínica da demência (Clinical Dementia Rating scale - CDR). A amostra foi constituída de 67 idosos. Os dados foram coletados em entrevistas domiciliares, utilizando-se de instrumento para identificação e perfil sociodemográfico, do Mini Exame do Estado Mental (MEEM) para avaliação do déficit cognitivo, da Medida de Independência Funcional (MIF) para avaliação da funcionalidade e, para estagiamento da demência, foi utilizada CDR. A média de idade dos idosos foi de 79 anos (+ 7,2), sendo 41,8% na faixa etária entre 75-79 anos. Houve predominio de mulheres 77,6% e viúvos 49,3%. Os idosos possuíam média de escolaridade de 5,6 anos, 73,1% tinham renda própria, 46,3% possuíam renda familiar de até 5 salários mínimos e residiam em média com 3,5 pessoas. Quanto às comorbidades existentes, 23,9 não possuíam e 53,7% tinham hipertensão arterial. O déficit cognitivo foi de 82%, e a média no MEEM de 9,3. Sobre o estagiamento da demência, 46,3% apresentavam demência grave, 22,4%% demência moderada e 31,3% demência leve. Quanto a funcionalidade, a variação dos escores observados na MIF foi igual à variação possível para MIF motora. A média geral da MIF global encontrada foi 71,1, a médias da MIF global foram 107,9; 84,5 e 39,7 para os idosos com demência leve, moderada e grave respectivamente. Os idosos com demência leve possuíam independência modificada ou necessitavam de supervisão, aqueles com demência moderada possuíam dependência mínima ou necessidade de supervisão e os idosos com demência grave eram totalmente dependentes. Foi encontrada forte correlação entre o nível de independência funcional (MIF global) com o estágio da demência e com o desempenho cognitivo (p<0,001). Não foram encontradas correlações estatisticamente significantes entre a funcionalidade e idade, sexo e presença de (co)morbidades. Concluiu-se que a capacidade funcional dos idosos com DA está relacionada ao estágio da demência, isto é, quanto mais grave a demência, maior o nível da dependência. / Functional capacity emerges as a new concept in elderly health, mainly with respect to elderly people with Alzheimers disease (AD), when a cognitive deficit is expected, connected with a functional deficit. Thus, research on functional capacity in elderly people with AD is relevant for elderly care delivery. This observational, crosssectional study aimed to identify co-morbidities of elderly people with AD, to measure the functional independence level according to the Functional Independence Measure (FIM), in comparison with the dementia staging according to the Clinical Dementia Rating scale (CDR). The sample consisted of 67 elderly. Data were collected during interviews at the elderlys home, using an identification and sociodemographic profile instrument, the Mini-Mental State Examination (MMSE) to assess cognitive deficit; the Functional Independence Measure (FIM) for functional assessment, and CDR to asses dementia staging. The mean age was 79 years (+ 7.2), with 41.8% between 75 and 79 years old. Women 77.6% and widowed people 49.3% were predominant. The elderlys mean education level was 5.6 years, 73.1% gained their own income, 46.3% gained a family income of up to 5 minimum wages and lived with an average of 3.5 people. As to existing co-morbidities, 23.9 had none and 53.7% had arterial hypertension. The cognitive deficit was 82% and the mean MMSE score 9.3. In dementia staging, 46.3% presented severe, 22.4%% moderate and 31.3% light dementia. With respect to functionality, the variation in FIM scores was equal to the possible variation for motor FIM. The mean global general FIM score was 71.1, the mean global FIM scores were 107.9 for light; 84.5 for moderate and 39.7 for severe dementia. Elderly with light dementia displayed modified independence or needed supervision; those with moderate dementia showed minimal dependence or supervision and elderly with severe dementia were fully dependent. A strong correlation was found between the functional independence level (global FIM) and dementia stage and with cognitive performance (p<0.001). No statistically significant correlations were found between functionality and age, gender and presence of co-morbidities. It was concluded that the functional capacity of elderly people with AD is related with the stage of dementia, that is, the more severe the dementia, the higher the level of dependence will be.

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...