Does the functional assessment measure (FAM) extend the functional independence measure (FIM) instrument? A rasch analysis of stroke inpatients.

Adding the items of the Functional Assessment Measure (FAM) to the Functional Independence Measure (FIM instrument) has been proposed as a method to extend the range of the FIM, particularly when assessing functional status in rehabilitation patients with brain injury, including stroke. It has been proposed that this approach is especially helpful in ameliorating ceiling effects when brain-injured patients have reached the end of their inpatient rehabilitation stay or are being seen in outpatient settings. In the present study, 376 consecutive stroke patients on a Canadian inpatient rehabilitation unit were concurrently administered the FIM and the FAM. Rasch analysis was used to evaluate how well the FAM items extended the difficulty range of the FIM for both the Motor and Cognitive domains. Within the Motor domain, only the FAM item assessing Community Access was found to be more difficult than extant FIM items, and this item showed some tendency to misfit with the other motor items. In the Cognitive domain, the only FAM item with a higher difficulty level than the FIM items was that assessing Employability. Notably, strict adherence to scoring guidelines for these two FAM items requires taking patients out into the community to evaluate their actual performances, a practice unlikely in the typical inpatient stroke rehabilitation unit. Results indicate that use of the entire FAM as an adjunct to the FIM reduces test efficiency while providing only minimal additional protection against ceiling effects.

When is ethical review of research protocols necessary? A proposed classification system for evaluating Canadian hospital-based research.

Although research is an activity commonly undertaken in Canadian hospitals, no mandatory or even standardized mechanism exists for the ethical clearance of hospital-based research in Canada. This paper describes the current procedures used by Canadian hospitals to evaluate research protocols. A research classification system is proposed by SCO Hospital, Saint-Vincent Pavilion. The proposed classification system offers criteria for screening hospital-based research for risk to human subjects and detecting potential ethical problems in a proposed research study. SCO Hospital, Saint-Vincent Pavilion, has also found the proposed research classification system helpful in identifying research activities that have an impact on hospital resources.

Pre-injury emotional trauma and chronic back pain. An unexpected finding.

STUDY DESIGN: A retrospective study investigated pre-injury emotional trauma in out-of-work, blue collar patients with chronic back pain (N = 27) who participated in a 30-hour workshop in which a wide range of cognitive skills was taught to help patients with rehabilitation and return them to work. OBJECTIVES: This study identified categories of pre-injury emotional trauma, calculated summary statistics, and performed category comparisons. METHODS: The categories of abandonment, emotional abuse, physical abuse, and sexual abuse emerged from the data. Frequencies and percentages in each category were calculated. Chi-square tests compared the differences in emotional trauma and gender. RESULTS: Statistically more patients reported abandonment and emotional abuse than physical and sexual abuse. There were no differences in trauma rates by gender. The results of the study revealed a high rate of pre-injury emotional trauma in patients with chronic back pain. CONCLUSION: Including pre-injury emotional trauma in psychologic evaluations of patients with chronic back pain and high psychologic test scores is recommended.