Abstract
Glenny C, Stolee P, Thompson M, Husted J, Berg K. Underestimating physical function
gains: comparing FIM motor subscale and interRAI Post Acute Care activities of daily
living scale.
Objective
To investigate the construct validity of the activities of daily living (ADLs) sections
of 2 major systems developed to measure functional ability in rehabilitation settings.
Health assessment systems can inform care planning as well as policy decision-making
on service effectiveness. Frailty, comorbidity, and heterogeneity make it difficult
to accurately measure health outcomes for older adults. Objective investigation of
the value of geriatric rehabilitation services requires assessment systems that are
comprehensive, reliable, valid, and sensitive to clinically relevant changes in older
patients.
Design
Trained health care workers assessed patients with both tools at admission and discharge.
We used Rasch analysis to compare the instruments' dimensionality, item difficulty,
item fit, differential item function, and number of response options.
Setting
Musculoskeletal and geriatric rehabilitation units in 2 Ontario hospitals.
Participants
Older adults receiving rehabilitation (N=209; mean age ± SD, 78.5±9.3; 67% women).
Interventions
Not applicable.
Main Outcome Measures
FIM and the interRAI Post Acute Care Assessment (interRAI PAC).
Results
For both the FIM motor and the interRAI PAC ADLs items, the difficulty level of the
items was much lower than the participant's level of ability, resulting in a large
ceiling effect. Also, on both scales, less actual change in functional ability was
required to move between the midlevel response options.
Conclusions
Both scales have limited ability to discriminate between subjects with higher functional
ability, which indicates that they may underestimate the effectiveness of inpatient
rehabilitation for this group of patients when used alone.
Key Words
List of Abbreviations:
ADLs (activities of daily living), CPC (category probability curve), GRU (geriatric rehabilitation unit), IADLs (instrumental activities of daily living), ICC (item characteristic curve), interRAI PAC (interRAI Post Acute Care Assessment), MSK (musculoskeletal rehabilitation unit)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 12, 2012
Footnotes
Supported by the Ontario Rehabilitation Research and Advisor Network and Health Canada: Primary Health Transitions Fund (grant no. ON421).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Apr 12, 2012, at www.archives-pmr.org.
Reprints are not available from the author.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
