Beninato Marianne, Gill-Body Kathleen M, Salles Sara, Stark Paul C, Black-Schaffer Randie M, Stein Joel
Graduate Programs in Physical Therapy, MGH Institute of Health Professions, Boston, MA 02129, USA.
Arch Phys Med Rehabil. 2006 Jan;87(1):32-9. doi: 10.1016/j.apmr.2005.08.130.
To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke.
Prospective case series discharged over a 9-month period.
Long-term acute care hospital.
Patients with stroke (N=113).
Not applicable.
Admission, discharge, and change scores were calculated for the total FIM, motor FIM, and cognitive FIM. Assessments of clinical change were rated at discharge on a 15-point (-7 to +7) Likert scale by attending physicians, with MCID defined at a cutoff score of 3. The FIM change scores associated with MCID were identified from receiver operating characteristic curves. Bayesian analysis was used to determine the probability of individual patients achieving MCID.
FIM change scores associated with MCID were 22, 17, and 3 for the total FIM, motor FIM, and cognitive FIM, respectively. The accuracy of the MCID was greater when subjects were categorized based on admission FIM scores than when considering the sample as a whole. Larger FIM change scores were related to MCID in subjects with lower admission FIM scores.
These findings will assist in the interpretation of FIM change scores relative to physicians' assessments of important clinical change.
确定FIM量表在脑卒中患者中的最小临床重要差异（MCID）。
对9个月期间出院的患者进行前瞻性病例系列研究。
长期急性护理医院。
脑卒中患者（N = 113）。
不适用。
计算FIM总分、运动FIM和认知FIM的入院、出院及变化得分。主治医生在出院时采用15分（-7至+7）李克特量表对临床变化进行评估，MCID定义为截断分数3。通过受试者工作特征曲线确定与MCID相关的FIM变化得分。采用贝叶斯分析确定个体患者达到MCID的概率。
FIM总分、运动FIM和认知FIM与MCID相关的变化得分分别为22、17和3。根据入院FIM得分对受试者进行分类时，MCID的准确性高于将样本作为一个整体考虑时。入院FIM得分较低的受试者中，较大的FIM变化得分与MCID相关。
这些发现将有助于根据医生对重要临床变化的评估来解释FIM变化得分。
