Subacute casemix classification for stroke rehabilitation in Australia. How well does AN-SNAP v2 explain variance in outcomes?

This study sought the best predictors for length of stay, discharge destination and functional improvement for inpatients undergoing rehabilitation following a stroke and compared these predictors against AN-SNAP v2.

Chief Investigator: Dr Friedbert Kohler
Partner Investigators: Roger Renton, Hugh Dickson, John Estell and Carol Connolly
Progress: Project completed 2010, published February 2011.
Outcomes: The best explanatory variable in our inpatient rehabilitation service is the admission motor FIM. AN- SNAP v2 classification is a less effective explanatory variable. This needs to be taken into account when using AN-SNAP v2 classification for clinical or funding purposes.
Links: To read the abstract please click here.

Project Contact Details
Dr Friedbert Kohler                           
P 9616 8638 
E F.Kohler@unsw.edu.au

Developing Core Sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning

The functional impairments caused by amputation include mobility, activities of daily living, body image and sexuality. Classification, measurement and comparison of the consequences of amputations has been impeded by the limited availability of internationally, multiculturally standardised instruments in the amputee setting. In 2001, the World Health Assembly introduced the International Classification of Functioning, Disability and Health to assess, describe and compare function and disability. The objective of this paper is to outline the development process for the ICF core sets for persons following amputation.

Chief Investigator: Dr Friedbert Kohler
Partner Investigators: Alarcos Cieza, Gerold Stucki, Jan Geertzen, Helena Burger, Michael P.Dillon, Carolina Schiappacasse, Alberto Esquenazi, Robert Steven Kistenberg and Nenad Kostanjsek.
Status: Project completed June 2009. Project commenced ICF Core Sets are practical tools for different purposes.
Outcomes: They allow clinicians and researchers to classify and describe individual’s functioning by using the most relevant ICF codes. The Brief ICF Core Set may facilitate international studies and studies comparing the consequences of different conditions. The Comprehensive ICF Core Set can be used in the clinic as a checklist to assess patient’s needs, to formulate rehabilitation goals and to evaluate progress. After a consensus conference, which will integrate evidence from preparatory studies, validation of the ICF core sets will follow with field-testing. The development of ICF Core Sets is an inclusive and open process. Clinical and consumer experts are encouraged to actively participate in the process.

Project Contact Details
Dr Friedbert Kohler                           
P 9616 8638 
E F.Kohler@unsw.edu.au

Agreement of functional independence measure item scores in patients transferred from one rehabilitation setting to another

Classification and payment systems that incorporate a functional measure used in routine clinical practice can only be as accurate as the underlying functional measure. The test-retest reliability in clinical practice of the individual item scores of the Functional Independence Measure (FIM), a functional measure used in classification and payment systems has been investigated. The aim of this study was to analyse paired measurements of FIM item scores carried out in routine clinical practice for patients transferred from one Rehabilitation Unit to another, and to determine the interrater reliability using standard measures of agreement and bias.

Chief Investigator: Dr Friedbert Kohler
Partner Investigators: Dickson H, Redmond H, Estell J, Connolly C.

Status: Project completed December 2009.
Outcomes: Paired FIM item scores from143 patients were included in the review. Raw agreement between the two scores for each FIM item was low, with a mean of 54 + 18 pairs (%) matching. The range of difference between scores was wide. Weighted kappa values were generally in the fair agreement range as were the intraclass correlation coefficients. Tests for bias and homogeneity showed that just over half of the items had significant differences in the two sets of scores. Weighted k showed only fair agreement for FIM items. Contributing factors for this could include incomplete FIM training of some staff, insufficient attention to accurate scoring, actual clinical changes, differences between patient performance in different settings, and variation in scoring because of the large number of staff involved in scoring the FIM in the multidisciplinary team within our settings. Caution needs to be exercised when utilizing the FIM individual item scores in clinical practice as part of clinical or funding classifications or in benchmarking as this study indicates only fair inter-rater reliability of these scores in clinical practice.

Project Contact Details
Dr Friedbert Kohler                           
P 9616 8638 
E F.Kohler@unsw.edu.au

Interrater reliability of functional status scores for patients transferred from one rehabilitation setting to another

The objective of this project is to report the interrater reliability of FIM total score, FIM motor subscore, and FIM cognitive subscore from scoring that occurred in routine clinical practice in 2 closely linked inpatient rehabilitation services in Sydney, Australia.

Chief Investigator: Dr Friedbert Kohler
Partner Investigators: Redmond H, Dickson H, Connolly C, Estell J
Status: Completed July 2010.
Outcomes: There was no systematic scoring bias evident. Intraclass correlation coefficients were high, but tests of agreement demonstrated poor agreement. These findings have implications for the use of the FIM and any patient classification or funding system based on the FIM, especially if poor levels of agreement were found in the presence of all staff being FIM credentialed and standardization of methods of assessment. This study indicates that further investigation of agreement of both FIM totals and FIM item scores in the clinical setting is warranted.

Project Contact Details
Dr Friedbert Kohler                           
P 9616 8638 
E F.Kohler@unsw.edu.au

Last updated 24 March 2011