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When working in the out-patient setting for a patient of chronic heart failure focusing on self-care, it is not possible to find a functional outcome tool to meet this exact need on rehabmeasures.org. This tool I found to be most applicable to patients in this setting due to the likely clinical presentation of a patient with this disorder. Patients of chronic heart failure in the out-patient setting will likely be able to be independent in most activities of daily living, therefore allowing this tool to include more of the IADL’s (Instrumental Activities of Daily Living) needed. The CHART is designed to assess physical independence, cognitive independence, mobility, occupation, social integration, and economic self-sufficiency. Due to 32 in-depth questions, it is not a quickly administered tool to use while working with the patient, as it will take up valuable time. But this test is thorough in determining specifics of the persons’ daily life. Specifically, the Craig Hospital in Denver, CO specializes in Neurovascular Rehabilitation, but due to the criteria included and the patient population this test would be applicable to the chronic heart failure demographic. Scoring of the assessment is simple and easily determined, with some time to add up the totals and interpret the results. For the Craig Handicap Assessment and Resource Technique, lower scores indicate greater degree of handicap.
Maura Bigman and Gregory Edwards, SPT
Home Care Setting
Sarah Hapgood, SPT
Functional Independence Measure
The Functional Independence Measure or FIM is a tool used to assess how much assistance an individual ability to perform activities of daily living (ADL) and their level of disability1. The FIM consist of 13 motor and 5 cognitive items scored on a 7 point ordinal scale, with a score range of 18 (total dependence) to 126 (total independence)1,2. Scores are easily interpreted and guidance can be found in the user manual1. Minimal cost is associated with the FIM; however an individual must complete an hour long training course to administer the FIM via the Uniform Data System for Medical Rehabilitation1. It takes approximately 30-45 minutes to complete the FIM2.
The FIM has not been validated in home health patients with heart failure, but has been validated in the geriatric population and those with cardiac disease1,3. Heart failure is most common over age 65; this age group is considered to be the geriatric population4,5. Sansone et al. have found the FIM to be a valid measure for inpatient cardiac rehab, which includes patients with heart failure3. Considering these facts and the ease of completing the FIM, I find the FIM to be a valid and reliable measure for assessing ADL in patients with heart failure in the home health setting.
The Barthel Index (BI) is used to assess an individual’s ability to care for oneself in 10 ADLs, 8 self -care and 2 mobility categories6,7. Items are arbitrarily weighted and scores range from 0 (totally dependent) to 100 (totally independent)7. A BI evaluation can last from a few minutes to an hour and is typically performed by a caregiver who is familiar with the individuals’ abilities and medical history7.
The FIM and BI asses the level of assistance an individual needs to complete ADLs. Both the BI and the FIM have been shown to be valid and reliable with minimal ceiling and floor effects1,6. The FIM captures more information in greater detail than the BI and is the most widely used ADL assessment tool in rehabilitation7. The BI measures on a 3 point scale from totally dependent to totally independent, whereas the FIM has a more detailed 7 point ordinal scale adding a greater level of insight to an individual’s abilities 1,6,7. The Barthel is available for free, can be less time consuming to fill out and is more easily interpreted. The Barthel includes activities such as feeding, a vital ADL, but typically not in the scope of practice of physical therapists. The FIM is more sensitive to change than the BI7. Both tools have been validated for geriatrics but not specifically individuals with heart failure or in the home health setting. Given the details above, the FIM is a more appropriate choice for individuals with heart failure in the home health setting for physical therapist due to the greater sensitivity of change and the focus on multifactorial motor function tasks7.
1. Rehabilitation Institue of Chicago. Functional independence measure. Rehab Measures - Functional Independence Measure Web site. http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=889. Updated 2010. Accessed January/21, 2013.
2. Conner D, Barnes C, Harrison-Felix C, Reznickova N. Rehabilitation outcomes in a population of nonagenarians and younger seniors with hip fracture, heart failure, or cerebral vascular accident. Arch Phys Med Rehabil. 2010;91(10):1505-1510. doi: 10.1016/j.apmr.2010.07.004; 10.1016/j.apmr.2010.07.004.
3. Sansone GR, Alba A, Frengley JD. Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program. Arch Phys Med Rehabil. 2002;83(4):506-512.
4. Heart Failure Society of America. Quick facsts and questions about heart failure. Heart Failure Society of America Web site. http://www.hfsa.org/heart_failure_facts.asp. Accessed January/22, 2013.
5. American Geriatrics Society. Whats different about the 65+ age group? American Geriatics Society Web site. http://www.americangeriatrics.org/files/documents/stats/slide_11_33.pdf. Accessed January/22, 2013.
6. Rehabilitation Institue of Chicago. Barthel index. Rehab Measures - Barthel Index Web site. http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=916. Updated 2010. Accessed January/21, 2013.
7. Cohen ME, Marino RJ. The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil. 2000;81(12 Suppl 2):S21-9.