Granger C V, Hamilton B B, Linacre J M, Heinemann A W, Wright B D
Department of Rehabilitation Medicine, State University of New York, Buffalo.
Am J Phys Med Rehabil. 1993 Apr;72(2):84-9. doi: 10.1097/00002060-199304000-00005.
The functional independence measure (FIM) is used to determine the degree of disability that patients experience and the progress that they make through programs of medical rehabilitation. Rasch analysis is a statistical technique for constructing interval measures from ordinal data that was applied to derive FIM measures. The major factors that are taken into account to produce FIM measures are the relative difficulty in performance of FIM items and the ability of the persons tested. Our analyses showed the relative difficulties that patients experienced in performing items in the FIM. There were two dominant patterns of difficulty, one for motor FIM items and the other for cognitive FIM items. The patterns were consistent across impairment groups, although not identical. Of the motor items, eating and grooming were easiest whereas stair climbing, tub/shower transfers and locomotion were most difficult. Of the cognitive items, expression and comprehension were easiest and problem solving was the most difficult. The patterns of difficulty in performing FIM items are illustrated by analysis of the following impairment groups: for motor items, orthopedic conditions, stroke with left hemiparesis and spinal cord dysfunction; for cognitive items, orthopedic conditions, brain dysfunction, stroke with right hemiparesis and spinal cord dysfunction. By understanding patterns of difficulty in performing FIM items according to types of impairment and levels of function, clinicians may more precisely design treatment programs, use services and predict outcomes of medical rehabilitation.
功能独立性测量（FIM）用于确定患者所经历的残疾程度以及他们通过医学康复计划所取得的进展。拉施分析是一种从序数数据构建区间测量的统计技术，被应用于推导FIM测量值。产生FIM测量值时考虑的主要因素是FIM项目执行的相对难度以及被测试者的能力。我们的分析显示了患者在执行FIM项目时所经历的相对困难。有两种主要的困难模式，一种是针对运动FIM项目，另一种是针对认知FIM项目。这些模式在不同损伤组中是一致的，尽管并非完全相同。在运动项目中，进食和梳洗最容易，而爬楼梯、从浴缸/淋浴间转移和移动最困难。在认知项目中，表达和理解最容易，解决问题最困难。通过分析以下损伤组来说明执行FIM项目时的困难模式：对于运动项目，包括骨科疾病、左半身偏瘫的中风和脊髓功能障碍；对于认知项目，包括骨科疾病、脑功能障碍、右半身偏瘫的中风和脊髓功能障碍。通过根据损伤类型和功能水平了解执行FIM项目时的困难模式，临床医生可以更精确地设计治疗方案、利用服务并预测医学康复的结果。
