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Arch Phys Med Rehabil. 2013 Aug;94(8):1521-1526.e4. doi: 10.1016/j.apmr.2013.02.019. Epub 2013 Mar 5.

Validity and reliability of the FIM instrument in the inpatient burn rehabilitation population.

Author information

1
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA. pbgerrard@partners.org

Abstract

OBJECTIVE:

To provide evidence of construct validity for the FIM instrument in the inpatient rehabilitation burn population.

DESIGN:

Confirmatory factor analysis and item response theory were used to assess construct validity. Confirmatory factor analysis was performed on a 2-factor model of the FIM instrument and on a 6-subfactor model. Mokken scale analysis, a nonparametric item response theory, was performed on each of the FIM instrument's 2 major factors, motor and cognitive domains. Internal consistency using Cronbach alpha and Molenaar and Sijtsma's statistic was also examined.

SETTING:

Inpatient rehabilitation facilities.

PARTICIPANTS:

Data from the Uniform Data System for Medical Rehabilitation for patients with an impairment code of burn injury from the years 2002 to 2011 were used for this analysis. A total of 7569 subjects were included in the study.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Comparative fit index results for the confirmatory factor analyses and adherence to assumptions of the Mokken scale model.

RESULTS:

Confirmatory factor analysis provided a comparative fit index of .862 for the 2-factor model and .941 for the 6-subfactor model. Mokken scale analysis showed scalability coefficients of .681 and .891 for the motor and cognitive domains, respectively. Measures of internal consistency statistic gave values of >.95 for each major domain of the FIM instrument.

CONCLUSIONS:

The FIM instrument has evidence of validity and reliability as an outcome measure for patients with burn injuries in the inpatient rehabilitation setting. The 6-subfactor model provides a better fit than the 2-factor model by confirmatory factor analysis. There is evidence that the motor and cognitive domains each form valid unidimensional metrics based on nonparametric item response theory.

KEYWORDS:

Burns; CFA; Factor analysis; IIO; IRT; MSA; Mokken scale analysis; Outcome measures; Psychometrics; Rehabilitation; Validation; confirmatory factor analysis; invariant item ordering; item response theory

PMID:
23473701
DOI:
10.1016/j.apmr.2013.02.019
[Indexed for MEDLINE]

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