Clinical utility of the AlphaFIM® instrument in stroke rehabilitation.
Summary of "Clinical utility of the AlphaFIM® instrument in stroke rehabilitation."
BACKGROUND:
The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items.
AIM:
To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes.
METHODS:
In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions.
RESULTS:
The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R(2) 0·40 and 0·28, respectively; P < 0·0001) and was weakly correlated with FIM gain and length of stay (adjusted R(2) 0·04 and 0·09, respectively; P < 0·0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain.
CONCLUSIONS:
The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.
Affiliation
Neuro Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Journal Details
This article was published in the following journal.
Name: International journal of stroke : official journal of the International Stroke Society
ISSN: 1747-4949
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22103839
- DOI: http://dx.doi.org/10.1111/j.1747-4949.2011.00694.x
Medical and Biotech [MESH] Definitions
Rehabilitation Nursing
The diagnosis and treatment of human responses of individuals and groups to actual or potential health problems with the characteristics of altered functional ability and altered life-style. (American Nurses Association & Association of Rehabilitation Nurses. Standards of Rehabilitation Nursing Practice, 1986, p.2)
Blood Viscosity
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Questionnaires
Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.
National Institute Of Neurological Disorders And Stroke
Component of the NATIONAL INSTITUTES OF HEALTH. It supports and conducts research, both basic and clinical, on the normal and diseases nervous system. It was established in 1950.
Stroke
A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)
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