Jones C Allyson, Feeny David H
Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
Arch Phys Med Rehabil. 2006 Oct;87(10):1382-7. doi: 10.1016/j.apmr.2006.06.008.
To evaluate the agreement between patient and proxy responses of the FIM instrument at 4 different periods of time during the first 6 months after hip fracture.
Prospective cohort study.
A large urban health region with 2 tertiary hospitals that treat hip fractures.
Patients (n=137) who were 65 years or older, admitted to the health region with a primary diagnosis of hip fracture, who had Mini-Mental State Examination scores greater than 17. Family caregivers (n=137) participated as proxy respondents.
Not applicable.
The FIM instrument. Agreement was evaluated at each of the 4 assessments during the 6-month follow-up after hip fracture using intraclass correlation coefficient.
FIM scores improved over the 6 months with the greatest improvement occurring within the first month of recovery. Agreement was higher for more observable activities than less observable ones. The magnitude of agreement improved over the 6 months with the proportion of clinically important systematic differences decreasing over time. Agreement for change scores was lower than the agreement at each of the 4 assessments.
Patient-proxy agreement levels are acceptable; the agreement varies with the subscale and the recovery phase. Substitution of proxy for patient responses across time may be used guardedly when patient responses are missing.
评估髋部骨折后前6个月内4个不同时间段患者与代理人对功能独立性测量（FIM）工具的回答之间的一致性。
前瞻性队列研究。
一个拥有2家治疗髋部骨折的三级医院的大型城市健康区域。
137名65岁及以上、因髋部骨折为主诊断入住该健康区域且简易精神状态检查表得分高于17分的患者。137名家庭照顾者作为代理人参与。
不适用。
FIM工具。在髋部骨折后6个月的随访期间，使用组内相关系数对4次评估中的每次评估的一致性进行评估。
FIM评分在6个月内有所改善，最大改善发生在恢复的第一个月内。对于更易观察的活动，一致性高于较难观察的活动。一致性程度在6个月内有所提高，临床上重要的系统差异比例随时间下降。变化分数的一致性低于4次评估中每次评估的一致性。
患者与代理人的一致性水平可以接受；一致性因分量表和恢复阶段而异。当患者的回答缺失时，跨时间用代理人回答替代患者回答时应谨慎使用。
