Article

PURPOSE: To present our experience in measuring rehabilitation achievements of
post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients' various disability levels and describe our
experience with other measuring tools in patients less sensitive to changes in
the FIM instrument. METHODS: A retrospective study performed in a post-acute
geriatric rehabilitation center. Three hundred and eighty-seven hip fractured
patients admitted from January 2010 to May 2012 were included in this study.
Patients were evaluated by the Functional Independence Measure (FIM), the Timed
Get Up and Go (TUG) test and "bed to chair" transfer FIM parameter. The study
population was divided into three disability groups according to their admission
disability level: high (admission FIM score <40), moderate (FIM 40-79) and low
(FIM >/= 80). The Mann-Whitney U, ANOVA and Chi square tests analyzed the data.
RESULTS: The FIM instrument was found most sensitive in identifying functional
change in patients with moderate disability. Low disability patients received
more physio- and occupational-therapy treatment time, yet achieved a lower mean
FIM score change compared to moderately disabled patients. The smallest real
difference (SRD = 13) for the FIM score was achieved by 60% of patients with
moderate disability. When assessed by the TUG test, most patients (94%) improved
their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen
patients (35.9%) achieved a discharge score of <20 s. The high disability group
achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients
required considerable help in transferring from bed to chair (FIM 1-2), however,
upon discharge, the majority (69.2%) improved to the level of a one man transfer
(FIM >/= 3). Forty-one (64.1%) patients were discharged home. CONCLUSION:
Post-acute hip fracture patients exhibit variable functional ability. Assessing
rehabilitation achievements with a disability measure is limited; therefore, it
is advisable to use an instrument most suitable to the patients' disability
level.

Langue : ANGLAIS