Article

OBJECTIVE: To report the interrater reliability of FIM total score, FIM motor
subscore, and FIM cognitive subscore from scoring that occurred in routine
clinical practice in 2 closely linked inpatient rehabilitation services in
Sydney, Australia. DESIGN: A natural-experiment blind clinical interrater
reliability cohort study of the FIM across 2 rehabilitation units. SETTING: This
study is set in 2 inpatient rehabilitation units immediately adjacent to each
other in southwestern Sydney, New South Wales, Australia. PARTICIPANTS: All
patients (N=143) who were transferred between the 2 rehabilitation units between
August 2006 and October 2007 were included in the study. INTERVENTION: Discharge
FIMs were scored by the first unit and an admission FIM was scored independently
by the second unit within a few days. The FIM scores were analyzed for agreement
and systematic bias. MAIN OUTCOME MEASURE: Intraclass correlation coefficients,
kappa statistic, weighted kappa statistic, and Bland-Altman plots were used.
RESULTS: There were 143 sets of scores identified. The range of differences
between the 2 FIM totals was -32 to 50, between the FIM motor subscores was -22
to 43, and between the FIM cognitive subscores was -14 to 21. Bland-Altman plots
demonstrated poor agreement. Few FIM totals were perfectly matched. The
intraclass correlation coefficients ranged from .872 for the FIM total to .830
for the cognitive subscales. Values for kappa ranged from -.007 (FIM motor
subscore) to .123 (FIM cognitive subscore). Values for weighted kappa ranged from
.465 (FIM cognitive subscore) to .521 (FIM total). CONCLUSIONS: There was no
systematic scoring bias evident. Intraclass correlation coefficients were high,
but tests of agreement demonstrated poor agreement. These findings have
implications for the use of the FIM and any patient classification or funding
system based on the FIM, especially if poor levels of agreement were found in the
presence of all staff being FIM credentialed and standardization of methods of
assessment. This study indicates that further investigation of agreement of both
FIM totals and FIM item scores in the clinical setting is warranted.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS