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Linking existing instruments to develop a continuum of care measure: accuracy comparison using function-related group

Chih-Ying Li1, Sergio Romero2,3, Kit N Simpson4,5

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Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation
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This study compared the accuracy of different test forms for measuring self-care physical function using the Functional Independence Measure (FIM™) and Minimum Data Set (MDS). Results show accuracy varies by test length and comparison level, supporting the use of existing instruments for care measurement.

Keywords:
Activities of daily livingClassificationContinuity of patient careOutcome assessment (health care)Veterans

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Area of Science:

  • Rehabilitation Medicine
  • Health Services Research
  • Biostatistics

Background:

  • Accurate measurement of physical function is crucial for patient care and research.
  • The Functional Independence Measure (FIM™) and Minimum Data Set (MDS) are widely used instruments for assessing patient function.
  • Developing shorter test forms can improve efficiency but may impact measurement accuracy.

Purpose of the Study:

  • To compare the measurement accuracy of self-care physical function test forms with varying item counts (13, 8, and 4 items).
  • To evaluate test forms generated from a combined item bank of FIM™ and MDS.
  • To assess the impact of test form length on measurement accuracy at individual and group levels.

Main Methods:

  • Retrospective analysis of data from 2499 Veterans who completed both FIM™ and MDS assessments within 6 days.
  • Comparison of converted FIM™ motor scores (FIMc) from MDS data against original FIM™ motor scores (FIMa).
  • Measurement accuracy assessed at individual levels (point differences) and group levels (function-related groups - FRGs).

Main Results:

  • Mean score differences between FIMa and FIMc ranged from 0.05 to 1.07 points across all test forms.
  • Over 81% of FIMc scores from the 13-item MDS form were within 15 points of FIMa scores.
  • Function-related group (FRG) agreement between FIM short forms and FIMa ranged from 59.9% to 90.5%, with higher agreement for specific conditions (stroke, amputation, joint replacement).

Conclusions:

  • Measurement accuracy is influenced by the comparison level (individual vs. group), test form length, and the specific FRG used.
  • Results partially support the use of existing instruments with reduced item counts for generating continuum of care measurements.
  • Further research is needed to optimize short-form test development for reliable physical function assessment.