PREDICTIVE VALUE OF THE INITIAL FIM SCORE IN DETERMINING REHABILITATION OUTCOMES AFTER ISCHEMIC STROKE
Keywords:
stroke, Barthel Index, FIM score, rehabilitationAbstract
The primary goal of specific stroke treatment is to reduce brain damage caused by ischemia. In assessing the consequences of a stroke, we use various measuring instruments that provide us with data on the remaining functional abilities. The functional assessment enables the assessment of the patient's disability when performing specific activities, which will also enable the rehabilitation process to be directed to those activities that are most damaged and have the greatest impact on the patient's quality of life. Among the most commonly used functional questionnaires are the Barthel index, which assesses motor functioning only, and the FIM, which assesses motor and cognitive functioning.
This observational, clinical study was conducted on 60 patients with stroke who were admitted for inpatient physical therapy at the Clinic for Physical Medicine and Rehabilitation of the University Clinical Center in Sarajevo. Stroke diagnosis was previously confirmed by a neurologist based on clinical and imaging exams. On admission, each patient underwent a detailed physical examination, and the Barthel index and FIM score were calculated. After the rehabilitation, each patient was re-measured with the Barthel index and FIM score upon discharge. Statistical analysis was performed and p value of <0.05 was taken as statistical significance.
Statistically significant difference in the average values of the Barthel index at admission and discharge was 2.85±2.13 (t=-10.365; df=59; p=0.001). Significant difference in FIM score at admission and discharge was 22.95±14.54 ( 12.219; df=59; p=0.001). The average improvement in functional independence (FI) was 22.95, ranging from 2 to 55. Total 17 patients had an improvement in FIM score of 1 10 points at discharge compared to admission, 8 patients had an improvement of 11 20 points, 17 had an improvement of 21 30 points, 11 had an improvement of 31 40 points, 3 of 41 50 points and 4 patients had an improvement of 51 60 points.
After rehabilitation, there was a significant improvement in the functional independence of patients after stroke, as evidenced by higher values of the Barthel Index and FIM score at discharge compared to values at admission. The study confirms the importance of using standardized scales and instruments in monitoring the impact of rehabilitation procedures and further planning of patient recovery
References
Ancheta, J., Husband, M., Law, D., & Reding, M. (2000). Initial Functional Independence Measure Score and Interval Post Stroke Help Assess Outcome, Length of Hospitalization, and Quality of Care. Neurorehabilitation and Neural Repair, 14(2), 127–134.
Angelopoulou, E., Koros, C., Stanitsa, E., Stamelos, I., Kontaxopoulou, D., Fragkiadaki, S., Papatriantafyllou, J. D., Smaragdaki, E., Vourou, K., Pavlou, D., Bamidis, P. D., Stefanis, L., & Papageorgiou, S. G. (2024). Neurological Examination via Telemedicine: An Updated Review Focusing on Movement Disorders. Medicina, 60(6), 958.
Barthels, D., & Das, H. (2020). Current advances in ischemic stroke research and therapies. Biochimica et Biophysica Acta. Molecular Basis of Disease, 1866(4), 165260.
Boehme, C., Toell, T., Lang, W., Knoflach, M., & Kiechl, S. (2021). Longer term patient management following stroke: A systematic review. International Journal of Stroke, 16(8), 917–926.
Bonkhoff, A. K., Hope, T., Bzdok, D., Guggisberg, A. G., Hawe, R. L., Dukelow, S. P., Chollet, F., Lin, D. J., Grefkes, C., & Bowman, H. (2022). Recovery after stroke: the severely impaired are a distinct group. Journal of Neurology, Neurosurgery, and Psychiatry, 93(4), 369–378.
Bottemiller, K. L., Bieber, P. L., Basford, J. R., & Harris, M. (2006). FIM Scores, FIM Efficiency, and Discharge Disposition Following Inpatient Stroke Rehabilitation. Rehabilitation Nursing, 31(1), 22–25.
Caronni, A., & Scarano, S. (2024). Generalisability of the Barthel Index and the Functional Independence Measure: robustness of disability measures to Differential Item Functioning. Disability and Rehabilitation, 1–12.
Elendu, C., Amaechi, D. C., Elendu, T. C., Ibhiedu, J. O., Egbunu, E. O., Ndam, A. R., Ogala, F., Ologunde, T., Peterson, J. C., Boluwatife, A. I., Okongko, A. O., Fatoye, J. O., Akpovona, O. L., Onyekweli, S. O., Temitope, A. Y., Achimugu, A. O., & Temilade, A. V. (2023). Stroke and cognitive impairment: understanding the connection and managing symptoms. Annals of Medicine and Surgery, 85(12), 6057.
Filipska-Blejder, K., Durszlewicz, J., & Ślusarz, R. (2024). Characteristics of the Functional Independence Measure (FIM) Scale in Terms of Neurological Conditions. The Journal of Neurological and Neurosurgical Nursing, 13(3), 119–123.
Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., & Granger, C. V. (1994). Interrater reliability of the 7-level functional independence measure (FIM). Scandinavian Journal of Rehabilitation Medicine, 26(3), 115–119.
He, J., Yuan, Z., Quan, L., Xi, H., Guo, J., Zhu, D., Chen, M., Yang, B., Cui, Z., Zhu, S., & Qiao, J. (2025). Multimodal assessment of a BCI system for stroke rehabilitation integrating motor imagery and motor attempts: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 22(1).
Kelly, P. J., Furie, K. L., Shafqat, S., Rallis, N., Chang, Y., & Stein, J. (2003). Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. Archives of Physical Medicine and Rehabilitation, 84(7), 968–972.
Lee, E. Y., Sohn, M. K., Lee, J. M., Kim, D. Y., Shin, Y. I., Oh, G. J., Lee, Y. S., Lee, S. Y., Song, M. K., Han, J. H., Ahn, J. H., Lee, Y. H., Chang, W. H., Choi, S. M., Lee, S. K., Joo, M. C., & Kim, Y. H. (2022). Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. International Journal of Environmental Research and Public Health, 19(15), 9612.
Lee, K. E., Choi, M., & Jeoung, B. (2022). Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review. International Journal of Environmental Research and Public Health, 19(19), 12739.
Li, X., He, Y., Wang, D., & Rezaei, M. J. (2024). Stroke rehabilitation: from diagnosis to therapy. Frontiers in Neurology, 15(15).
Poomalai, G., Prabhakar, S., & Sirala Jagadesh, N. (2023). Functional Ability and Health Problems of Stroke Survivors: An Explorative Study. Cureus, 15(1).
Pournajaf, S., Pellicciari, L., Proietti, S., Agostini, F., Gabbani, D., Goffredo, M., Damiani, C., & Franceschini, M. (2023). Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study. International Journal of Rehabilitation Research, 46(3), 230–237.
Rayegani, S. M., Raeissadat, S. A., Alikhani, E., Bayat, M., Bahrami, M. H., & Karimzadeh, A. (2016). Evaluation of complete functional status of patients with stroke by Functional Independence Measure scale on admission, discharge, and six months poststroke. Iranian Journal of Neurology, 15(4), 202.
Shahid, J., Kashif, A., & Shahid, M. K. (2023). A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sciences, 13(5), 717.
Sodero, A., Campagnini, S., Paperini, A., Castagnoli, C., Hochleitner, I., Politi, A. M., Bardi, D., Benedetta Basagni, Barretta, T., Guolo, E., Tramonti, C., Pancani, S., Bahia Hakiki, Grippo, A., Mannini, A., Benedetta Nacmias, Baccini, M., Macchi, C., & Cecchi, F. (2023). Predicting the functional outcome of intensive inpatient rehabilitation after stroke: results from the RIPS Study. European Journal of Physical and Rehabilitation Medicine, 60(1).
Summerton, T. (2023). The effect of functional electrical stimulation of the abdominal muscles on motor performance and activity of the trunk in patients with stroke: A pilot study. Handle.net.
Turki Aljuhani, Shahd Al Subaie, Alghamdi, R., None Nasser Altwaim, None Abdullah Aljabr, Alotaibi, N. S., None Ghalib Al-Gamdi, & Almutairi, A. M. (2024). Predict Factors that Influence Stroke Recovery and Function Using FIM Score at Discharge in a Tertiary Hospital. Deleted Journal, 3(6), 264–271.
Wilkinson, I., & Harper, A. (2020). Comprehensive geriatric assessment, rehabilitation and discharge planning. Medicine, 49(1).
Yang, C. M., Wang, Y.-C., Lee, C.-H., Chen, M.-H., & Hsieh, C.-L. (2020). A comparison of test–retest reliability and random measurement error of the Barthel Index and modified Barthel Index in patients with chronic stroke. Disability and Rehabilitation, 44(10), 1–5.
