James A. Eddy Memorial Foundation Research Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY 12308, USA.
Department of Physical Medicine and Rehabilitation, Sunnyview Rehabilitation Hospital, Schenectady, NY 12308, USA.
Arch Phys Med Rehabil. 2023 Dec;104(12):1995-2001. doi: 10.1016/j.apmr.2023.07.009. Epub 2023 Aug 1.
To validate Sections GG (Self-Care and Mobility Assessment), B (Hearing, Speech, and Vision), and C (Cognitive Patterns) of the Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument (CMS-IRF PAI) Version 1.4 in comparison with Functional Independence Measure (FIM) motor subscale (FIMm) and cognitive subscale (FIMc).
Retrospective cohort.
Single inpatient rehabilitation facility.
Cohort of 1296 patients admitted for rehabilitation after stroke, between October 1, 2016, and October 1, 2019.
Not applicable.
Sections GG, B, and C scores were compared with FIMm and FIMc using Spearman's and Bland-Altman Analyses.
Sections GG and FIMm were highly correlated on admission (ρ=0.919, P<.001) and discharge (ρ=0.929, P<.001). Ceiling effects at discharge were more pronounced for Section GG (8.6%). Bland-Altman analyses revealed a bias toward higher scores on Section GG vs FIMm on admission (Bias=2.3%, P<.001), and discharge (Bias=6.2%, P<.001). Section GG showed bias toward greater gains in function (Bias=3.9%, P<.001), particularly in walking and stairs (bias=3.71%, P<.001). Comparable self-care items accounted for a smaller percentage of the Section GG gains compared with FIMm (bias=-7.5%, P<.001). The internal validity of a scale consisting of Section B and C (B+C scale) was good, (Cronbach's alpha=0.868) and was highly correlated with FIMc (ρ=0.745), but rated patients at a higher level of cognition (bias=20.0%, P<.001) and had a greater ceiling effect (20.4%) on admission compared with the FIMc (0.6%).
The B+C scale and Section GG were correlated with FIMc and FIMm subscales but biased toward higher ratings of ability. Ceiling effects may limit discrimination at higher level of cognition/functional independence. The clinical acceptability of Section GG total scores as an outcome measure and predictor of long-term outcomes requires further study.
验证医疗保险和医疗补助服务中心住院康复设施患者评估工具（CMS-IRF PAI）版本 1.4 的 GG（自理和移动能力评估）、B（听力、言语和视力）和 C（认知模式）部分与功能独立性测量（FIM）运动分量表（FIMm）和认知分量表（FIMc）的相关性。
回顾性队列研究。
单家住院康复机构。
2016 年 10 月 1 日至 2019 年 10 月 1 日期间因中风接受康复治疗的 1296 名住院患者。
不适用。
使用 Spearman 分析和 Bland-Altman 分析比较 GG 部分、B 部分和 C 部分与 FIMm 和 FIMc 的得分。
GG 部分和 FIMm 在入院时（ρ=0.919，P<.001）和出院时（ρ=0.929，P<.001）高度相关。出院时 GG 部分的天花板效应更为明显（8.6%）。Bland-Altman 分析显示，入院时 GG 部分的得分高于 FIMm（偏差=2.3%，P<.001），出院时（偏差=6.2%，P<.001）。GG 部分显示出在功能方面更大的增益的偏差（偏差=3.9%，P<.001），特别是在行走和楼梯（偏差=3.71%，P<.001）方面。与 FIMm 相比，GG 部分的自理项目占增益的比例较小（偏差=-7.5%，P<.001）。由 B 部分和 C 部分（B+C 部分）组成的量表具有良好的内部有效性（Cronbach's alpha=0.868），与 FIMc 高度相关（ρ=0.745），但对认知能力的评估较高（偏差=20.0%，P<.001），且在入院时与 FIMc（0.6%）相比，天花板效应更高（20.4%）。
B+C 部分和 GG 部分与 FIMc 和 FIMm 分量表相关，但偏向于更高的能力评分。天花板效应可能会限制在更高的认知/功能独立性水平上的区分度。GG 部分总分作为结局测量和长期结局预测指标的临床可接受性需要进一步研究。
