Hong Kong Institute of Education, Hong Kong.
Neurorehabil Neural Repair. 2013 Feb;27(2):125-32. doi: 10.1177/1545968312457828. Epub 2012 Aug 31.
Tools used to measure poststroke functional status must include basic and instrumental activities of daily living and reflect the patient's and the clinician's perspective of the disease and its effect on daily living performance.
The authors combined the Functional Independence Measure (FIM) and the Nottingham Extended Activities of Daily Living (NEADL) to create a scale providing a comprehensive evaluation of ADLs functional status in patients with stroke.
The study participants were 188 patients completing the FIM and the NEADL. The psychometric properties of the combined measure were examined with Rasch analysis.
A 3-point scale and a dichotomous scale were suggested for use in the FIM and the NEADL, respectively. The combined 40 items worked consistently to reflect a single construct, and "bladder management" and "bowel management" were highly related. After "bowel management" was removed from the combined scale, all but 3 items fit the model's expectations, and the 39-item scale showed reasonable item difficulty hierarchy, with high reliability. The 3 misfit items were removed, and no differences in unidimensionality, differential item functioning, and reliability were found between the 36-item and 39-item scales.
The combined measure of the FIM and the NEADL provides a comprehensive picture of ADLs. It extends the utility of the FIM and the NEADL and is recommended for use to measure the independence of patients after discharge home.
用于测量卒中后功能状态的工具必须包括基本的和工具性的日常生活活动，并反映患者和临床医生对疾病及其对日常生活活动能力影响的看法。
作者将功能独立性测量（FIM）和诺丁汉扩展日常生活活动（NEADL）相结合，创建了一个综合评估卒中患者日常生活活动能力的量表。
研究参与者为 188 名完成 FIM 和 NEADL 的患者。使用 Rasch 分析检查组合测量的心理测量特性。
建议在 FIM 和 NEADL 中分别使用 3 分制和二分制量表。组合的 40 个项目一致地反映了一个单一的结构，并且“膀胱管理”和“肠道管理”高度相关。将“肠道管理”从组合量表中删除后，除了 3 个项目外，所有项目都符合模型的预期，39 个项目的量表显示出合理的项目难度层次结构，具有较高的可靠性。删除了 3 个不匹配的项目，在一维性、差异项目功能和可靠性方面，36 项和 39 项量表之间没有差异。
FIM 和 NEADL 的组合测量提供了日常生活活动的全面情况。它扩展了 FIM 和 NEADL 的用途，建议在出院回家后用于测量患者的独立性。
