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Functional independence staging: conceptual foundation, face validity, and empirical derivation.
Margaret G Stineman1, Richard N Ross, Roger Fiedler
1Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, Clinical Epidemiology Unit, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
Archives of Physical Medicine and Rehabilitation
|February 18, 2003
Summary
A new staging system, ASME, was developed to measure functional independence in daily activities, sphincter management, mobility, and executive functions. This system provides a common language for assessing patient recovery and setting meaningful goals.
Area of Science:
- Rehabilitation Medicine
- Functional Assessment
- Disability Studies
Background:
- The Functional Independence Measure (FIM) is widely used but lacks a standardized staging system for functional independence.
- A need exists for a system aligned with the International Classification of Functioning, Disability and Health (ICF) to categorize functional recovery.
- Current assessment methods may not adequately capture the nuanced progression of functional recovery across different domains.
Purpose of the Study:
- To develop a staging system for functional independence across Activities of Daily Living (ADLs), Sphincter-management, Mobility, and Executive-function domains (ASME).
- To ensure the ASME staging system is consistent with the International Classification of Functioning, Disability and Health (ICF) framework.
- To create a standardized method for describing functional outcomes in rehabilitation.
Main Methods:
- Utilized national data from 218,290 individuals discharged from 560 US inpatient rehabilitation facilities in 1995.
- Defined seven stages for each ASME domain by identifying configurations of FIM item scores that indicated progressive functional ability.
- Analyzed activity profiles derived from FIM scores to establish stage-specific performance levels.
Main Results:
- Developed seven distinct stages for each of the ASME domains, reflecting increasing levels of patient effort and independence.
- Stage 1 represents minimal effort (<25%) with total assistance, while Stage 7 signifies complete independence (100% effort).
- Demonstrated that fundamental activities (e.g., eating, transfers) are mastered at lower stages, while complex functions (e.g., problem-solving, stair climbing) are achieved at higher stages.
Conclusions:
- The ASME staging system provides a common language and shorthand for functional consequences of illness and injury.
- This system complements impairment and diagnosis information, enhancing communication among patients, caregivers, and clinicians.
- Facilitates more meaningful assessment and goal setting by describing functional status in standardized terms.