title: The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke from the National UK Clinical Dataset.
abstract: The UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010-2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.
authors.affiliation: Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom.|Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Nayar
authors.affiliation: Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom.
authors.forename: Roxana
authors.initials: R
authors.lastname: Vanderstay
authors.affiliation: School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Northcote, Auckland, New Zealand.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Siegert
authors.affiliation: Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom.|Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom.
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D054022:Cerebrum / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D003071:Cognition / Q000502:physiology; D016208:Databases, Factual; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D000066530:Neurological Rehabilitation / Q000379:methods*; D011594:Psychometrics / Q000379:methods*; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D006113:United Kingdom
references.citation: Disabil Rehabil. 2002 May 10;24(7):383-9
references.pmid: 12022789
references.citation: Lancet. 1991 Jun 22;337(8756):1521-6
references.pmid: 1675378
references.citation: Neurology. 1996 Aug;47(2):388-92
references.pmid: 8757009
references.citation: Stroke. 2003 Oct;34(10):2392-6
references.pmid: 12958320
references.citation: J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):749-54
references.pmid: 10567491
references.citation: Brain. 2000 Jan;123 ( Pt 1):74-81
references.pmid: 10611122
references.citation: Disabil Rehabil. 2012;34(22):1871-9
references.pmid: 22506959
references.citation: Neurol Neurochir Pol. 2012 Jul-Aug;46(4):351-6
references.pmid: 23023434
references.citation: J Rehabil Med. 2011 Oct;43(10):884-91
references.pmid: 21947180
references.citation: BMJ. 2009 Apr 02;338:a3167
references.pmid: 19342403
references.citation: J Outcome Meas. 1999;3(4):339-59
references.pmid: 10572386
references.citation: Clin Rehabil. 1999 Aug;13(4):277-87
references.pmid: 10460115
references.citation: Neurology. 2001 Aug 28;57(4):639-44
references.pmid: 11524472
references.citation: J Neurol Neurosurg Psychiatry. 2002 Aug;73(2):188-90
references.pmid: 12122181
references.citation: Neurology. 2004 Aug 10;63(3):468-74
references.pmid: 15304577
references.citation: Scand J Occup Ther. 2016 Sep;23(5):398-404
references.pmid: 26463478
references.citation: Stroke. 1997 Jun;28(6):1174-80
references.pmid: 9183346
references.citation: Neurology. 1989 May;39(5):638-43
references.pmid: 2710353
references.citation: Stroke. 1993 Aug;24(8):1178-81
references.pmid: 8342193
references.citation: Int J Rehabil Res. 2011 Mar;34(1):89-91
references.pmid: 20520563
references.citation: Disabil Rehabil. 2009;31(10):825-30
references.pmid: 19037776
references.citation: J Rehabil Med. 2009 Jun;41(7):528-35
references.pmid: 19543663
references.citation: Disabil Rehabil. 2013;35(22):1885-95
references.pmid: 23384240
references.citation: Clin Rehabil. 2001 Oct;15(5):562-72
references.pmid: 11594646