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Evaluating the FONE FIM: Part I. Construct validity
W C Chang1, S Slaughter, D Cartwright
1Department of Public Health Sciences, Faculty of Medicine and Oral Health Sciences, University of Alberta, Edmonton, Canada.
Abstract:
Rasch analysis was used in this paper to evaluate the Motor component of the FONE FIM, the telephone version of the Functional Independence Measure (FIM). For this purpose, 132 patients discharged from an inpatient geriatric assessment and rehabilitation program were assessed by trained research assistants using the FONE FIM. The results at 5 weeks post-discharge were compared to the observation FIMs (OBS FIMs) done at home 6 weeks post-discharge. These patients had an average age of 79 years and presented with multiple, complex medical problems and significant functional decline. The FONE FIM and the OBS FIM were shown to share a strikingly similar item hierarchy, based on Rasch item difficulty measures. Only bladder management and climbing stairs were misfitting items as indicated by item fit statistics. The same 13-item set and 4-point scales were shown to be psychometrically optimal for both the FONE FIM and the OBS FIM based on the person separation index. Further research is required to address the issue of the optimal item set and scale levels from psychometric and clinical perspectives.
Insights
The telephone version of the Functional Independence Measure (FONE FIM) accurately assesses geriatric patients
Area of Science:
- Gerontology
- Rehabilitation Medicine
- Psychometrics
Background:
- Geriatric patients often experience functional decline after inpatient rehabilitation.
- Accurate functional assessment is crucial for effective care planning and outcome measurement.
- The Functional Independence Measure (FIM) is a widely used tool, but a telephone version (FONE FIM) may improve accessibility.
Purpose of the Study:
- To evaluate the psychometric properties of the Motor component of the FONE FIM.
- To compare the FONE FIM with in-home observational FIM (OBS FIM) assessments in geriatric patients.
Main Methods:
- Rasch analysis was applied to data from 132 geriatric patients.
- Patients were assessed using the FONE FIM and OBS FIM approximately 5-6 weeks post-discharge.
- Item hierarchy, fit statistics, and person separation index were analyzed.
Main Results:
- The FONE FIM demonstrated a similar item hierarchy to the OBS FIM, indicating comparable measurement properties.
- Bladder management and climbing stairs were identified as potential areas for refinement.
- A 13-item set with 4-point scales was found to be psychometrically optimal for both assessment methods.
Conclusions:
- The FONE FIM shows strong psychometric validity for assessing motor function in geriatric patients.
- Further research is needed to optimize the item set and scale levels for clinical and psychometric utility.
- The FONE FIM offers a viable alternative for functional status assessment in this population.