Using EFA and FIM rating scales could provide a more complete assessment of patients with acquired brain injury

Abstract

Purpose: In some hospitals, patients exhibit significant heterogeneity of function at admission and discharge. The current study aims to assess if concurrent usage of the Early Functional Assessment (EFA) and Functional Independence Measure (FIM®) is warranted and practical in rehabilitation centers with diverse patient groups and outcomes. Methods: This retrospective study examined a data set of all patients with concurrent EFA and FIM scores admitted to a single rehabilitation center (4076 scores from 1251 patients). The patients had acquired brain injury of multiple etiologies and a range of severities. Results: The EFA scale was more able to characterize the function of lower functioning patients according to the FIM while the FIM scale was more able to characterize the function of higher functioning patients according to the EFA. This was highlighted by 21% of assessments with the lowest FIM score (18) having corresponding EFA scores of 22–76 and 27% of assessments with the highest EFA score (>90) having corresponding FIM scores of 38–126. Conclusions: In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury. The EFA/FIM scale could be used concurrently in certain patients providing a more complete view of patients throughout the rehabilitation process.

Implications for Rehabilitation

• Rehabilitation scales can be administered on multiple occasions to track the progress of a patient throughout the rehabilitation process; however, a lot of popular scales (such as the FIM®) are limited containing ceiling and floor effects for higher and lower functioning patients, respectively.

• In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury.

• Concurrent usage of the scales could be indicated for some patients and each scale could provide information that the other scale does not provide however the FIM and EFA scales should be administered solely for EFA scores >90 (FIM administered solely) and the lowest FIM scores (EFA administered solely).

• Brain injury
• disability
• EFA
• FIM
• functional independence measure

Acknowledgements

Thanks to Jesper Mortensen for collating and organising the data. Additional thanks goes to the multidisciplinary scoring team.