Smith P M, Illig S B, Fiedler R C, Hamilton B B, Ottenbacher K J
Rehabilitation Research and Training Center on Functional Assessment, Buffalo, NY, USA.
Arch Phys Med Rehabil. 1996 May;77(5):431-5. doi: 10.1016/s0003-9993(96)90029-5.
To examine the intermodal agreement of Functional Independence Measure (FIM) ratings when obtained by two commonly used approaches: telephone interview and in-person assessment of functional performance.
A random sample of 40 persons with hemiparesis was tested by two registered nurses trained in FIM definitions and telephone interview techniques. The two assessments occurred within 5 days of each other. The raters were blind to previous assessments. The administration of assessments was alternated to minimize bias and order effects.
All subjects were assessed at home, between 3 and 10 months after discharge from rehabilitation.
The criteria for inclusion were: (1) diagnosis of cerebral vascular accident (CVA); (2) completion of a minimum of 2 weeks in an acute rehabilitation program; (3) currently living at home; (4) living within a 30-mile radius of the hospital; and (5) cognitive and verbal skills adequate to complete a telephone interview. From a population of 103 patients, 40 subjects were randomly selected, 18 women and 22 men ranging in age from 37 to 90 years.
The intermodal agreement between FIM ratings obtained by telephone interview and in-person assessment was examined using the intraclass correlation (ICC). FIM item scores were analyzed for agreement using the Kappa coefficient. The stability of the responses was determined by computing the coefficient of variation and plotting the data to visually examine the relationship between the two methods of administration.
Data analysis revealed that there was no statistically significant difference (p > .05) between the two methods of administration for total FIM score. The total FIM ICC was .97. ICC values for FIM subscales ranged from .85 to .98, except for social cognition. Kappa scores for noncognitive items ranged from .49 (bowel movement) to .93 (grooming). The coefficient of variation computed to examine cognitive and communication items with reduced variability indicated good stability across all items.
The results indicated good intermodal agreement for follow-up telephone assessment using the Functional Independence Measure. The findings were limited to persons with effective communication skills.
通过两种常用方法获取功能独立性测量（FIM）评分，即电话访谈和功能表现的现场评估，以检验二者之间的多模式一致性。
对40名偏瘫患者进行随机抽样，由两名接受过FIM定义和电话访谈技术培训的注册护士进行测试。两次评估在彼此相隔5天内进行。评估者对之前的评估情况不知情。评估的实施顺序交替进行，以尽量减少偏差和顺序效应。
所有受试者均在康复出院后3至10个月在家中接受评估。
纳入标准为：（1）脑血管意外（CVA）诊断；（2）在急性康复项目中至少完成2周；（3）目前居住在家中；（4）居住在医院半径30英里范围内；（5）认知和语言能力足以完成电话访谈。从103名患者中随机选取40名受试者，其中18名女性和22名男性，年龄在37至90岁之间。
使用组内相关系数（ICC）检验电话访谈和现场评估获得的FIM评分之间的多模式一致性。使用Kappa系数分析FIM项目得分的一致性。通过计算变异系数并绘制数据直观检查两种评估方法之间的关系，以确定反应的稳定性。
数据分析显示，两种评估方法在FIM总分上无统计学显著差异（p>.05）。FIM总分的ICC为0.97。FIM子量表的ICC值范围为0.85至0.98，但社会认知子量表除外。非认知项目的Kappa评分范围为0.49（排便）至0.93（修饰）。计算得出的用于检查变异性降低的认知和沟通项目的变异系数表明，所有项目的稳定性良好。
结果表明，使用功能独立性测量进行随访电话评估具有良好的多模式一致性。研究结果仅限于具有有效沟通能力的人群。
