Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure

Background-The importance of evaluating disability outcome measures is well recognised. The Functional Independence Measure (FIM) was developed to be a more comprehensive and "sensitive" measure of disability than the Barthel Index (BI). Although the FIM is widely used and has been shown to be relia ble and valid, there is limited information about its responsiveness, parti cularly in comparison with the BI. This study compares the appropriateness and responsiveness of these two disability measures in patients with multip le sclerosis and stroke. Methods-Patients with multiple sclerosis (n=201) and poststroke (n=82) pati ents undergoing inpatient neurorehabilitation were studied. Admission and d ischarge scores were generated for the BI and the three scales of the FIM ( total, motor, and cognitive). Appropriateness of the measures to the study samples was determined by examining score distributions, floor and ceiling effects. Responsiveness was determined using an effect size calculation. Results-The BI, FIM total, and FIM motor scales show good variability and h ave small floor and ceiling effects in the study samples. The FIM cognitive scale showed a notable ceiling effect in patients with multiple sclerosis. Comparable effect sizes were found for the BI, and two FIM scales (total a nd motor) in both patients with multiple sclerosis and stroke patients. Conclusion-All measures were appropriate to the study sample. The FIM cogni tive Scale, however, has limited usefulness as an outcome measure in progre ssive multiple sclerosis. The BI, FIM. total, and FIM motor scales show sim ilar responsiveness, suggesting that both the FIM total and FIM motor scale s have no advantage over the BI in evaluating change.