Agreement between patient and proxy responses during recovery after hip fracture: evidence for the FIM instrument.
OBJECTIVE
To evaluate the agreement between patient and proxy responses of the FIM instrument at 4 different periods of time during the first 6 months after hip fracture.


METHODS
Prospective cohort study.


METHODS
A large urban health region with 2 tertiary hospitals that treat hip fractures.


METHODS
Patients (n=137) who were 65 years or older, admitted to the health region with a primary diagnosis of hip fracture, who had Mini-Mental State Examination scores greater than 17. Family caregivers (n=137) participated as proxy respondents.


METHODS
Not applicable.


METHODS
The FIM instrument. Agreement was evaluated at each of the 4 assessments during the 6-month follow-up after hip fracture using intraclass correlation coefficient.


RESULTS
FIM scores improved over the 6 months with the greatest improvement occurring within the first month of recovery. Agreement was higher for more observable activities than less observable ones. The magnitude of agreement improved over the 6 months with the proportion of clinically important systematic differences decreasing over time. Agreement for change scores was lower than the agreement at each of the 4 assessments.


CONCLUSIONS
Patient-proxy agreement levels are acceptable; the agreement varies with the subscale and the recovery phase. Substitution of proxy for patient responses across time may be used guardedly when patient responses are missing.
Jones
C Allyson
CA
Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada. cajones@ualberta.ca
Feeny
David H
DH
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D019727:Proxy / Q000523:psychology*; D015203:Reproducibility of Results; D018434:Sickness Impact Profile