G. Montagnani, PT, Weaning and Pulmonary Rehabilitation Unit, Auxilium Vitae, Volterra, Italy.
Phys Ther. 2011 Jul;91(7):1109-15. doi: 10.2522/ptj.20100369. Epub 2011 May 19.
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.
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.
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.
The FIM can be used as a functional status outcome measure in people for whom weaning from mechanical ventilation is difficult.
功能性独立性测量（FIM）已被提议作为慢性阻塞性肺疾病急性加重后接受肺康复治疗的患者的结局测量指标。目的 本研究旨在探讨 FIM 在机械通气撤机困难的患者撤机方案后的临床应用价值。设计 这是一项回顾性观察性研究。
回顾性评估接受了气管切开术、机械通气撤机困难且正在接受撤机方案（WP 组）的患者。将慢性阻塞性肺疾病急性加重后接受肺康复治疗的患者（PR 组）作为验证对照组纳入。在进入和离开方案时，评估 FIM 问卷和医学研究委员会呼吸困难评分。
比较了 WP 组 56 例和 PR 组 63 例患者的入院和出院数据。入院时，根据 FIM，WP 组 5 例（7.7%）患者被定义为功能独立，34 例（52.3%）患者被定义为部分依赖，26 例（40.0%）患者被定义为完全依赖。出院时，FIM 总分显著提高，从 47.9（SD=22.8）提高到 62.6（SD=30.0）。WP 组患者的 FIM 评分变化与入院时急性生理学和慢性健康评估（R=-.286）和简化急性生理学评分（R=-.293）呈显著负相关，与入院时 FIM 评分呈显著正相关（R=.355）。入院时，PR 组 46 例（67.7%）患者被定义为功能独立，19 例（27.9%）患者被定义为部分依赖，3 例（4.4%）患者被定义为完全依赖。肺康复治疗后，FIM 总分显著提高，从 97.4（SD=27.5）提高到 102.5（SD=25.7）。局限性 本研究未进行随机分组，样本量相对较小。
FIM 可作为机械通气撤机困难患者的功能状态结局测量指标。
