Original Research

Association Between Physiotherapy Outcome Measures and the Functional Independence Measure: A Retrospective Analysis

Journal of Clinical Outcomes Management. 2021 November;28(6):259-267 | doi:10.12788/jcom.0069

References

1. Centers for Disease Control and Prevention. Disability and health overview. Impairments, activity limitations and participation restrictions. September 16, 2020. https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html

2. The Royal Australasian College of Physicians. Australasian Faculty of Rehabilitation Medicine. Standards for the Provision of Inpatient Adult Rehabilitation Medicine Services in Public and Private Hospitals. February 2019:7-9. https://www.racp.edu.au/docs/default-source/advocacy-library/afrm-standards-for-the-provision-of-inpatient-adult-rehabilitation-medicine-services-in-public-and-private-hospitals.pdf?sfvrsn=4690171a_4

3. NSW Agency for Clinical Innovation. NSW rehabilitation model of care. June 1, 2015. https://aci.health.nsw.gov.au/resources/rehabilitation/rehabilitation-model-of-care/rehabilitation-moc

4. The State of Queensland (Queensland Health). Clinical task instructions. June 22, 2021. https://www.health.qld.gov.au/ahwac/html/clintaskinstructions

5. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157. doi:10.1111/j.1532-5415.2010.03234.x

6. Suwannarat P, Kaewsanmung S, Thaweewannakij T, Amatachaya S. The use of functional performance tests by primary health-care providers to determine walking ability with and without a walking device in community-dwelling elderly. Physiother Theory Pract. 2021;37(1):64-72. doi:10.1080/09593985.2019.1606372

7. Lee K-J, Um S-H, Kim Y-H. Postoperative rehabilitation after hip fracture: a literature review. Hip Pelvis. 2020;32(3):125-131. doi:10.5371/hp.2020.32.3.125

8. Wade DT, Smeets RJEM, Verbunt JA. Research in rehabilitation medicine: methodological challenges. J Clin Epidemiol. 2010;63(7):699-704. doi:10.1016/j.clinepi.2009.07.010

9. Wade DT. Outcome measures for clinical rehabilitation trials: impairment, function, quality of life, or value? Am J Phys Med Rehabil. 2003;82(suppl 10):S26-S31. doi:10.1097/01.PHM.0000086996.89383.A1

10. de Morton NA, Harding KE, Taylor NF, Harrison G. Validity of the de Morton NA Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation. Disabil Rehabil. 2013;35(4):325-333. doi:10.3109/09638288.2012.705220

11. Trøstrup J, Andersen H, Kam CAM, et al. Assessment of mobility in older people hospitalized for medical illness using the de Morton Mobility Index and cumulated ambulation score—validity and minimal clinical important difference. J Geriatr Phys Ther. 2019;42(3):153-160. doi:10.1519/JPT.0000000000000170

12. Gazzoti A, Meyer U, Freystaetter G, et al. Physical performance among patients aged 70+ in acute care: a preliminary comparison between the Short Physical Performance Battery and the De Morton Mobility Index with regard to sensitivity to change and prediction of discharge destination. Aging Clin Exp Res. 2020;32(4):579-586. doi:10.1007/s40520-019-1249-9

13. Tavares LS, Moreno NA, de Aquino BG, et al. Reliability, validity, interpretability and responsiveness of the DEMMI mobility index for Brazilian older hospitalized patients. PLoS One. 2020;15(3):e0230047. doi:10.1371/journal.pone.0230047

14. Braun T, Schulz R-J, Reinke J. Reliability and validity of the German translation of the de Morton Mobility Index performed by physiotherapists in patients admitted to a sub-acute inpatient geriatric rehabilitation hospital. BMC Geriatr. 2015;15:38. doi:10.1186/s12877-015-0035-y

15. Søndergaard K, Petersen LE, Pedersen MK, et al. The responsiveness and predictive validity of the de Morton Mobility Index in geriatric rehabilitation. Disabil Rehabil. 2020 Jun 12. [Epub ahead of print] doi:10.1080/09638288.2020.1771438

16. de Morton NA, Brusco NK, Wood L, et al. The de Morton Mobility Index (DEMMI) provides a valid method for measuring and monitoring the mobility of patients making the transition from hospital to the community: an observational study. J Physiother. 2011;57(2):109-116. doi:10.1016/S1836-9553(11)70021-2

17. Caronni A, Sterpi I, Antoniotti P, et al. Criterion validity of the instrumented Timed Up and Go test: a partial least square regression study. Gait Posture. 2018;61(3):287-293. doi:10.1016/j.gaitpost.2018.01.015

18. Kristensen MT, Bloch ML, Jonsson LR, Jakobsen TL. Interrater reliability of the standardized Timed Up and Go Test when used in hospitalized and community-dwelling individuals. Physiother Res Int. 2019;24(2):e1769. doi:10.1002/pri.1769

19. Yuksel E, Kalkan S, Cekmece S, et al. Assessing minimal detectable changes and test-retest reliability of the timed up and go test and 2-minute walk test in patients with total knee arthroplasty. J Arthroplasty. 2017;32(2):426-430. doi:10.1016/j.arth.2016.07.031

20. Yuksel E, Unver B, Kalkan S, Karatosun V. Reliability and minimal detectable change of the 2-minute walk test and Timed Up and Go test in patients with total hip arthroplasty. Hip Int. 2021;31(1):43-49. doi:10.1177/1120700019888614

21. Faleide AGH, Bogen BE, Magnussen LH. Intra-session test-retest reliability of the Timed “Up & Go” Test when performed by patients with hip fractures. Eur J Physiother. 2015;17(2):89-97. doi:10.3109/21679169.2015.1043579

22. Barry E, Galvin R, Keogh C, et al. Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatr. 2014;14:14. doi:10.1186/1471-2318-14-14

23. Kojima G, Masud T, Kendrick D, et al. Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial. BMC Geriatr. 2015;15:38. doi:10.1186/s12877-015-0039-7

24. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896-903.

25. Jeong SM, Shin DW, Han K, et al. Timed Up-and-Go test is a useful predictor of fracture incidence. Bone. 2019;127:474-481. doi:10.1016/j.bone.2019.07.018

26. Donaghue OA, Savva GM, Börsch-Supan A, Kenny RA. Reliability, measurement error and minimum detectable change in reliability measurement error and minimum detectable change in mobility measures: a cohort study of community dwelling adults aged 50 years and over in Ireland. BMJ Open. 2019;9(11):e030475. doi:10/1136.bmjopen-2019-030475

27. Freter SH, Fruchter N. Relationship between timed ‘up and go’ and gait time in an elderly orthopaedic rehabilitation population. Clin Rehabil. 2000;14(1):96-101. doi:10.1191/026921500675545616

28. Kear BM, Guck TP, McGaha AL. Timed up and go (TUG) test: normative reference values for ages 20 to 59 years and relationships with physical and mental health risk factors. J Prim Care Community Health. 2017;8(1):9-13. doi:10.1177/2150131916659282

29. Abellan van Kan G, Rolland Y, Andrieu S, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people: an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009;13(10)881-889. doi:10.1007/s12603-009-0246-z

30. Unver B, Baris RH, Yusel E, et al. Reliability of 4-meter and 10-meter walk tests after lower extremity surgery. Disabil Rehabil. 2017;39(25):2572-2576. doi:10.1080/09638288.2016.1236153

31. Fritz S, Lusardi M. White paper: “walking speed: the sixth vital sign.” J Geriatr Phys Ther. 2009;32(2):46-49.

32. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923

33. Bohannon R. Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997;26(1):15-19. doi:10.1093/ageing/26.1.15

34. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance in older adults. J Am Geriatr Soc. 2006;54(5):743-749. doi:10.1111/j.1532-5415.2006.00701.x

35. Hollman J, Beckman B, Brandt R, et al. Minimum detectable change in gait velocity during acute rehabilitation following hip fracture. J Geriatr Phys Ther. 2008;31(2):53-56. doi:10.1519/00139143-200831020-00003

36. Bohannon RW, Andrews AW. Normal walking speed: a descriptive meta-analysis. Physiotherapy. 2011;97(3):182-189. doi:10.1016/j.physio.2010.12.004

37. Granger CV, Hamilton BB, Keith RA, et al. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil. 1986;1:59-74.

38. Keith RA, Granger CV, Hamilton BB, Sherwin FS. The Functional Independence Measure: a new tool for rehabilitation. In: Eisenberg MG, Grzesiak RC, eds. Advances in Clinical Rehabilitation. Springer-Verlag; 1987:6-18.

39. Linacre JM, Heinemann AW, Wright BD, et al. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil. 1994;75(2):127-132.

40. Coster WJ, Haley SM, Jette AM. Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings. J Rehabil Med. 2006;38(4):237-242. doi:10.1080/16501970600609774

41. Street L. Frequently asked questions about FIM. Journal of the Australasian Rehabilitation Nurses Association. 2014;17(1):21-22. https://ro.uow.edu.au/ahsri/296/

42. Green JP, Gordon R, Blanchard MB, et al. Development of the Australian National Subacute and Non-acute Patient (AN-SNAP) Classification. Version 4 Final Report. Australian Health Services Research Institute, University of Wollongong, 2015. https://ro.uow.edu.au/ahsri/760

43. Australasian Rehabilitation Outcomes Centre. University of Wollongong, Australia. https://www.uow.edu.au/ahsri/aroc/

44. Green J, Gordon R, Kobel C, et al; Centre for Health Service Development. The Australian National Subacute and Non-acute Patient Classification. AN-SNAP V4 User Manual. May 2015. https://documents.uow.edu.au/content/groups/public/@web/@chsd/@aroc/documents/doc/uow194637.pdf

45. Alexander TL, Simmonds FD, Capelle JT, Green LJ. Anywhere Hospital AROC Impairment Specific Report on Reconditioning (Inpatient–Pathway 3), July 2018–June 2019. Australasian Rehabilitation Outcomes Centre, Australian Health Services Research Institute, University of Wollongong; 2019. ro.uow.edu.au/ahsri/1110

46. Evans JD. Straightforward Statistics for the Behavioural Sciences. Brooks/Cole Publishing; 1996.

47. Lee SP, Dufek J, Hickman R, Schuerman S. Influence of procedural factors on the reliability and performance of the timed up-and-go test in older adults. Int J Gerontol. 2016;10(1):37-42. doi:10.1016/j.ijge.2015

48. New PW, Scroggie GD, Williams CM. The validity, reliability, responsiveness and minimal clinically important difference of the de Morton Mobility Index in rehabilitation. Disabil Rehabil. 2017;39(10):1039-1043. doi:10.10801/09638288.2016.1179800

49. Nakaguchi T, Ishimoto Y, Akazawa N. Functional Independence Measure for patients with locomotor disorders in convalescent rehabilitation wards. Clinically significant minimum difference in exercise score gain. Physiotherapy Science. 2018;33(2):235-240.

It is important, too, to consider the ceiling effect for the FIM scores. For patients requiring a walking aid well after discharge, the highest level of independence from the walking aid will not be achieved. It is acknowledged that the floor effect of the 10MWT and TUG may also influence the outcomes of this study. In addition, data were not collected on preadmission functional measures to enable further evaluation of the population groups. The proportion of variance in change from admission to discharge for TUG and 10MWT to FIM was less than 5%, so the correlation interpretation from this type of scaling is limited. Further research into outcome measures for inpatient rehabilitation in respect to variables such as patient age, length of stay, discharge destination, and efficacy of intervention is warranted.

Conclusion

The FIM Motor change scores showed a weak positive association to the DEMMI change, and no association to the TUG and 10MWT change, demonstrating that the outcome measures do not measure the same attributes. Thorough reporting of clinical outcomes is much more meaningful to assess and guide the physiotherapy component of rehabilitation. To review rehabilitation effectiveness from a management perspective, it is recommended that all measures are reviewed to assess the burden of care, mobility, functional capacity, and dynamic balance.

Acknowledgements: The authors thank Anne Smith, MSHLM, BAppSc, Head of the Physiotherapy Department, and the physiotherapists and allied health assistants who have contributed to the collection of this valuable data over several years. They also thank Lina Baytieh, MS, BS, from Research Central, Illawarra Shoalhaven Local Health District, for her assistance with the analysis.

Corresponding author: Maren Jones, MPH, BS, Physiotherapy Department, Port Kembla Hospital, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, 2505 Australia; maren.jones@health.nsw.gov.au.

Financial disclosures: None.