Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature.
BACKGROUND
The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.


METHODS
English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.


RESULTS
In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.


CONCLUSIONS
Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.
Glenny
Christine
C
Department of Health Studies and Gerontology, University of Waterloo (200 University Avenue East), Waterloo (N2L 3G1), Canada. cglenny@uwaterloo.ca
Stolee
Paul
P
D000203:Activities of Daily Living; D000368:Aged; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results