Reliability and validity of the Spanish adaptation of the Functional Independence Measure + Functional Assessment Measure.

BACKGROUND: The Functional Independence Measure + Functional Assessment Measure (FIM+FAM) Scale is one of the most widely used instruments to measure functional independence post-stroke, and features many cultural adaptations to various languages. AIM: The aim of this study was to determine the psychometric properties of a Spanish cross-cultural adaptation of the FIM+FAM for use in the stroke population. DESIGN: Observational study. SETTING: Outpatient long-term service of a neurorehabilitation unit. POPULATION: One hundred and twenty-two individuals with stroke. METHODS: The functional independence of the participants was assessed with the adapted version of the FIM+FAM. Additionally, the functional, motor and cognitive condition of the participants was assessed with a battery of standardized clinical instruments. Finally, a group of 31 participants out of the total were evaluated a second time with the FIM+FAM by a different evaluator than the one who performed the first evaluation. Internal consistency, inter-rater reliability and convergent validity with other clinical instruments of the adapted version of the FIM+FAM were determined. RESULTS: The internal consistency of the adapted version of the FIM+FAM was excellent, as evidenced by Cronbach's α values that exceeded 0.973. The inter-rater reliability was likewise excellent, with correlations above 0.990 in all domains and subscales. Additionally, the convergent validity of the scale adaptation with clinical instruments was variable, with values ranging from 0.264 to 0.983, but consistent with the construct assessed in the different instruments examined. CONCLUSIONS: The internal consistency, inter-rater reliability and convergent validity of the Spanish-adapted version of the FIM+FAM Scale showed excellent reliability and validity of the adaptation, which supports its use to assess functional independence after stroke. CLINICAL REHABILITATION IMPACT: Availability of a valid adaptation for the evaluation of functional independence after stroke in Spanish population.

Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitación multidisciplinar / Disability after stroke: a longitudinal study in moderate and severe stroke patients included in a multidisciplinary rehabilitation program

Introducción. Los ictus son causa frecuente de discapacidad en el adulto; sin embargo, la repercusión que los déficits que acontecen tras un ictus moderado-grave tiene sobre el grado de discapacidad final, así como la respuesta de éstos a programas de rehabilitación, no se ha estudiado por completo. Pacientes y métodos. Se incluyeron 396 pacientes con Rankin modificado >= 3 después de un ictus isquémico (n = 221) o hemorrágico (n = 175). En todos los pacientes se evaluó su situación cognitiva, conductual, emocional, motora y funcional. Todos los pacientes fueron incluidos en un programa de rehabilitación multidisciplinar y reevaluados tras seis meses de tratamiento. Resultados. El riesgo de caída (escala de equilibrio de Berg < 45 en el 83,1% de la muestra) y los déficits funcionales (índice de Barthel < 75 en el 82,8% de la muestra) fueron los problemas más prevalentes en el momento del ingreso, mientras que los conductuales lo fueron en el del alta (55,1% de la muestra). Los problemas emocionales fueron los que más mejoraron, mientras que los conductuales fueron los que menos lo hicieron. El nivel de discapacidad global mejoró tras el tratamiento, aunque sólo un 11% de los pacientes, especialmente los que tenían buena situación cognitiva en el ingreso, lograron alcanzar una discapacidad leve. Conclusiones. Las consecuencias del ictus son multidimensionales. La afectación de las distintas esferas y el patrón de recuperación son diferenciales, con predominio a largo plazo de los problemas conductuales (AU)

Introduction. Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood. Patients and Methods: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program. Results: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up. Conclusions: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances (AU)