Archives of physical medicine and rehabilitation · 2006
Agreement between patient and proxy responses during recovery after hip fracture: evidence for the FIM instrument.
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Jones C Allyson, Feeny David H
Аннотация
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.
DESIGN: Prospective cohort study.
SETTING: A large urban health region with 2 tertiary hospitals that treat hip fractures.
PARTICIPANTS: 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.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: 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.
DESIGN: Prospective cohort study.
SETTING: A large urban health region with 2 tertiary hospitals that treat hip fractures.
PARTICIPANTS: 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.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: 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.