Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지

Rasch Analysis of FIM Physical Items in Patients With Stroke in Korea

뇌졸중 환자의 기능수준에 따른 FIM 신체적 기능 항목의 라쉬분석

  • Park, So-Yeon (Dept. of Physical Therapy, College of Alternative Medicine, Jeonju University) ;
  • Won, Jong-Im (Dept. of Physical Therapy, College of Alternative Medicine, Jeonju University) ;
  • Lee, Mi-Young (Dept. of Physical Medicine and Rehabilitation, Ajou University Hospital)
  • 박소연 (전주대학교 대체의학대학 물리치료학과) ;
  • 원종임 (전주대학교 대체의학대학 물리치료학과) ;
  • 이미영 (아주대학병원 재활의학과)
  • Received : 2010.03.15
  • Accepted : 2010.04.20
  • Published : 2010.05.21
Download PDF
⟨ Previous Next ⟩

Abstract

The Functional Independence Measure (FIM) is widely used to determine the dependency of activity of daily living in rehabilitation patients. The purposes of this study were to evaluate the unidimentionality of the FIM physical items and to analyze the validity of cross-functional levels in stroke survivors in Korea. Thirteen physical items of FIM were rated according to an ordinal scale of a 7-level classification. Two hundred and seventy-nine patients participated in the study (age range 18~92 years and 57% male). Six items-eating, bladder control, bowel control, transfer to and from the bed/wheelchair, transfer to and from the toilet, and bathing-showed misfits with the Rasch model. The most difficult item was 'bathing', the easiest item was 'bowel control'. Although there were several differences within functional levels, the hierarchical order of item measures was rather similar. 'Bathing' was the most difficult in high level patients (above 60), however 'stairs' was most difficult in the middle level (41~60) group. In the low level group (below 40), 'toileting' was the most difficult. In conclusion, the present study has shown several differences of item difficulty among functional levels. This result will be useful in planning interventions, and developing rehabilitation programs for stroke survivors.

Keywords

References

  1. 김원호, 박정일, 이세훈 등. 발병 3-6개월의 뇌졸중 환자에서 부가적 운동치료가 하지의 기능수행능력에 미치는 영향. 한국전문물리치료학회지. 2005;12(2):58-72.
  2. 박소연, 유은영. 한국 작업치료사의 평가도구 사용에 관한 연구. 대한작업치료학회지. 2002;10(2):99-108.
  3. 안덕현. 단기 가정방문물리치료 시행이 일상생활동작의 개선에 미치는 효과. 한국전문물리치료학회지. 2007;14(2):53-60.
  4. 유은영, 정민예, 박소연 등. 한국 작업치료사의 영역별 평가 도구 사용 동향. 대한작업치료학회지. 2006;14(3):27-37.
  5. 이청기, 박현, 조형제. 재활의학 분야에 사용하는 기능평가 척도의 비교. 대한재활의학회지. 1994;18(3);.500-511.
  6. 이충휘, 박소연. 대동작 기능 평가도구(GMFM)의 Rasch분석. 한국전문물리치료학회지. 2004;11(2):9-16.
  7. 이충휘. 물리치료사와 작업치료사를 위한 연구방법론. 3판. 서울, 계축문화사, 2007.
  8. 전은영. 뇌졸중 환자의 기능적 독립 상태(FIM) 및 가정간호 요구도 분석. 재활간호학회지. 2005;8(2):149-156.
  9. 정진화. 뇌졸중 환자의 일상생활동작 수행능력과 시지각 기능 및 상지 운동기능간의 상관성 연구. 삼육대학교 대학원, 석사학위논문, 2004.
  10. 통계청. 고령자 사망원인 분석결과. 2005. http://kostat.go.kr
  11. 황수진, 이수영, 이정아. 노인에게 있어서 Berg 균형척도, Timed Up & Go 검사, 기능적 독립평가(FIM)의 상관관계. 한국전문물리치료학회지. 2004;11(1):27-34.
  12. 홍순탁, 박형숙, 정은숙. FIM을 사용한 뇌졸중 환자의 퇴원시 기능상태 평가에 관한 연구. 재활간호학회지. 1998;1(1):73-82.
  13. Barker WH, Mullooly JP. Stroke in a defined elderly population, 1967-1985. A less lethal and disabling but no less common disease. Stroke. 1997;28(2):284-290. https://doi.org/10.1161/01.STR.28.2.284
  14. Bond TG, Fox CM. Applying the Rasch Model: Fundamental measurement in the human sciences. 2nd ed. New Jersey, Lawrence Erlbaum Associates Inc., 2007.
  15. DalImeijer AJ, Dekker J, Roorda LD, et al. Differential item functioning of the Functional Independence Measure in higher performing neurological patients. J Rehabil Med. 2005;37(6):346-352. https://doi.org/10.1080/16501970510038284
  16. Duncan PW, Bode RK, Min Lai S, et al. Rasch analysis of a new stroke-specific outcome scale: The Stroke lmpact Scale. Arch Phys Med Rehabil. 2003;84(7):950-963. https://doi.org/10.1016/S0003-9993(03)00035-2
  17. Dickson HG, Kohler F. The multi-dimensionality of the FIM motor items precludes an interval scaling using Rasch analysis. Scan J Rehab Med. 1996;28(3):159-162.
  18. Finch E, Brooks D, Stratford PW, et al. Physical Rehabilitation Outcome Measures: A guide to enhanced clinical decision making. 2nd ed. Ontario, BC Decker Inc., 2002.
  19. Granger CV, Hamilton BB, Linacre JM, et al. Performance profiles of the functional independence measure. Am J Phys Med Rehabil. 1993;72(2):84-89. https://doi.org/10.1097/00002060-199304000-00005
  20. Hwang O, Cho K. Translation and validity test of the FIM instrument and guide. The Korean Journal of Rehabilitation Nursing. 2001;4(2):232-239.
  21. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480-484.
  22. Jennett B, Snoek J, Bond MR, et al. Disability after severe head injury: Observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981;44(4):285-293. https://doi.org/10.1136/jnnp.44.4.285
  23. Koyama T, Matsumoto K, Okuno T, et al. Relationships between independence level of single motor-FIM items and FIM-motor scores in patients with hemiplegia after stroke: An ordinal logistic modelling study. J Rehabil Med. 2006;38(5):280-286. https://doi.org/10.1080/16501970600731420
  24. Linacre JM, Heinemann AW, Wright BD, et al. The structure and stability of the Functional lndependence Measure. Arch Phys Med Rehabil. 1994;75(2):127-132.
  25. Lundgren-Nilsson A, Grimby G, Ring H, et al. Cross-cultural validity of functional independence measure items in stroke: A study using Rasch analysis. J Rehabil Med. 2005;37(1):23-31. https://doi.org/10.1080/16501970410032696
  26. Lundgren-Nilsson A, Tennant A, Grimby G, et al. Cross-diagnostic validity in a generic instrument: An example from the Functional Independence Measure in Scandinavia. Health Qual Life Outcomes. 2006;4(55):1-8.
  27. Rasch G. Probabilistic Models for Some Intelligence and Attainment Tests. Chicago, University of Chicago Press. 1980.
  28. Sturm JW, Dewey HM, Donnan GA, et al. Handicap after stroke: How does it relate to disability, perception of recovery, and stroke subtype?: the north North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2002;33(3):762-768. https://doi.org/10.1161/hs0302.103815
  29. Tennant A, Penta M, Tesio L, et al. Assessing and adjusting for cross-cultural validity of impairment and activity limitation scales through differential item functioning within the framework of the Rasch model: The PRO-ESOR project. Med Care. 2004:42(1 suppl):I37-I48.
  30. Uniform Data System for Medical Rehabilitation. Guide for the Uniform Data Set for Medical Rehabilitation (Adult FIM). Ver. 4.0. Buffalo, UB Foundation Activities, Inc., 1993.
  31. van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604-607. https://doi.org/10.1161/01.STR.19.5.604
  32. Wade DT, Collin C. The Barthel ADL Index: A standard measure of physical disability? Int Disabil Stud. 1988;10(2):64-67. https://doi.org/10.3109/09638288809164105
  33. Wright BD, Masters GN. Rating Scale Analysis. Chicago, Mesa Press, 1982.