Article

The Functional Independence Measure (FIM) has been proposed as an
outcome measure for people receiving pulmonary rehabilitation after an acute
exacerbation of chronic obstructive pulmonary disease.
Objective The purpose of
this study was to examine the clinical utility of the FIM after a weaning program
in people for whom weaning from mechanical ventilation is difficult. Design This
was a retrospective observational study. METHODS: People who had had a
tracheostomy, for whom weaning from mechanical ventilation was difficult, and who
were participating in a weaning program (WP group) were retrospectively
evaluated. People receiving pulmonary rehabilitation after an acute exacerbation
of chronic obstructive pulmonary disease (PR group) were included as a validated
control group. The scores on the FIM questionnaire and the Medical Research
Council dyspnea scores were assessed at admission to and at discharge from the
programs. RESULTS: Admission and discharge data from 56 participants in the WP
group and 63 participants in the PR group were compared. At admission, according
to the FIM, 5 participants in the WP group (7.7%) were defined as functionally
independent, 34 (52.3%) were defined as partially dependent, and 26 (40.0%) were
defined as completely dependent. At discharge, the mean FIM global score was
significantly improved, from 47.9 (SD=22.8) to 62.6 (SD=30.0). For participants
in the WP group, changes in the FIM score were significantly inversely related to
the admission Acute Physiology and Chronic Health Evaluation (R=-.286) and
Simplified Acute Physiology (R=-.293) scores and directly related to the
admission FIM score (R=.355). At admission, 46 participants in the PR group
(67.7%) were defined as functionally independent, 19 (27.9%) were defined as
partially dependent, and 3 (4.4%) were defined as completely dependent. After
pulmonary rehabilitation, the mean FIM global score was significantly improved,
from 97.4 (SD=27.5) to 102.5 (SD=25.7). Limitations The study was not randomized
and involved a relatively small sample size. CONCLUSIONS: The FIM can be used as
a functional status outcome measure in people for whom weaning from mechanical
ventilation is difficult.

Langue : ANGLAIS