PRIMARY OBJECTIVE: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury. METHODOLOGY: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion. RESULTS: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time. CONCLUSIONS AND IMPLICATIONS: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.
PRIMARY OBJECTIVE: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury. METHODOLOGY: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion. RESULTS: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time. CONCLUSIONS AND IMPLICATIONS: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.
Authors: Erhard Næss-Schmidt; Nils-Bo de Vos Andersen; David Høyrup Christiansen; Jørgen Feldbæk Nielsen; Peter William Stubbs Journal: BMJ Open Date: 2020-11-03 Impact factor: 2.692