STRUCTURE OF A COMBINATION OF FUNCTIONAL INDEPENDENCE MEASURE AND INSTRUMENTAL ACTIVITY MEASURE ITEMS IN COMMUNITY-LIVING PERSONS - A STUDYOF INDIVIDUALS WITH CEREBRAL-PALSY AND SPINA-BIFIDA

Objective: To analyze the structure of a combination of physical items from the Functional Independence Measure (FIM) and seven instrumental activity items using ratings of dependence and perceived difficulty. Design: Disability in terms of dependence and subject's perceived diff iculty was studied in patients with cerebral palsy (CP) and spina bifi da (SE). Rasch analysis was used to construct calibrated linear measur e and to identify suitable models with respect to rating steps. Settin g: Interviews were performed at home with patients from an outpatient university rehabilitation unit for young disabled persons. Patients: F ifty-three CP and 20 SB patients (including 5 with other early acquire d spinal cord lesions), 20 to 39 years of age, participated and repres ented 62% and 80%, respectively, of available patients. All had fulfil led an elementary school program. Results: The best scoring model usin g Rasch analysis was achieved using 5 levels for dependence and 4 leve ls for perceived difficulty. Hierarchic orders for all items are prese nted. The FIM items Bowel and Bladder showed different characteristics in the two groups of patients, especially for perceived difficulty, a nd were excluded in the joint calibrations. There was close overall ag reement between the ratings of dependence and perceived difficulty. Pe rson measure values from the Rasch analyses were separated between whe elchair users and walkers. Conclusion: The combination of physical ite ms from FIM and instrumental activity measure (IAM) are useful for dis ability assessment in community-living persons and should be further s tudied in other impairment groups. (C) 1996 by the American Congress o f Rehabilitation Medicine and the American Academy of Physical Medicin e and Rehabilitation