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The Association Between the Functional Status Scale and the Pediatric Functional Independence Measure in Children Who
Aline B Maddux1, Matthew Cox-Martin2,3, Michael Dichiaro4
1Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Insights
The Functional Status Scale and Pediatric Functional Independence Measure show a correlation in children with traumatic brain injury. The Pediatric Functional Independence Measure is better for less severe injuries, while the Functional Status Scale suits more severe cases.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Clinical outcomes
Background:
- Traumatic brain injury (TBI) in children requires effective functional assessment during rehabilitation.
- The Functional Status Scale (FSS) and Pediatric Functional Independence Measure (PFIM) are used to evaluate functional status.
- Understanding the relationship between these scales is crucial for optimizing care.
Purpose of the Study:
- To determine the association between the Functional Status Scale (FSS) and Pediatric Functional Independence Measure (PFIM) scores in children recovering from TBI.
- To compare the utility of FSS and PFIM in different severity levels of pediatric TBI.
Main Methods:
- Secondary analysis of a prospective observational cohort study.
- Included 65 children (<18 years) admitted to ICU with acute TBI and transferred to inpatient rehabilitation.
- Assessed FSS and PFIM scores at transfer to rehabilitation and PFIM at discharge.
Main Results:
- A significant negative correlation was found between FSS and PFIM scores at rehabilitation transfer (r = -0.49).
- Higher FSS scores (indicating more disability) corresponded with lower PFIM scores.
- PFIM showed variability in less disabled patients (lower FSS), while FSS captured a wider range of disability in more severely injured patients.
Conclusions:
- Both FSS and PFIM are valuable in assessing functional status post-TBI in children.
- PFIM may be more advantageous for less severely injured children and task-specific assessments.
- FSS may be more suitable for more severely injured pediatric TBI survivors.
Objectives:
To determine the association between the Functional Status Scale and Pediatric Functional Independence Measure scores during the rehabilitation stay in children who survive traumatic brain injury.
Design:
Secondary analysis of a prospective observational cohort study.
Setting:
Tertiary care children's hospital with a level 1 trauma center and inpatient rehabilitation service.
Patients:
Sixty-five children less than 18 years old admitted to an ICU with acute traumatic brain injury and subsequently transferred to the inpatient rehabilitation service.
Interventions:
Not applicable.
Measurements And Main Results:
Functional Status Scale and Pediatric Functional Independence Measure at transfer to rehabilitation and Pediatric Functional Independence Measure at discharge from rehabilitation. The median age of the cohort was 7.1 years (interquartile range, 0.8-12.3 yr), and 29% were female. Nearly all of the children were healthy prior to the traumatic brain injury: six patients (9.2%) had a baseline Functional Status Scale score greater than 6. At the time of transfer to inpatient rehabilitation, total Functional Status Scale and Pediatric Functional Independence Measure scores had the expected negative correlation due to increasing disability resulting in lower scores in Pediatric Functional Independence Measure and higher scores in Functional Status Scale (r = -0.49; 95% CI, -0.62 to -0.35). Among subjects with less disability as measured by lower total Functional Status Scale scores, we found substantial variability in the total Pediatric Functional Independence Measure scores. In contrast, Pediatric Functional Independence Measure scores were consistently low among subjects with a wide range of higher total Functional Status Scale scores (more disability).
Conclusions:
Although proprietary and more time-intensive, the Pediatric Functional Independence Measure has advantages relative to the Functional Status Scale for less severely injured patients and task-specific measurements. The Functional Status Scale may have advantages relative to the Pediatric Functional Independence Measure for more severely injured patients. Further investigations are needed to characterize changes in the Functional Status Scale during the rehabilitation stay and after discharge.
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