Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury

Abstract

Objective: The increasing use of disability measures requires that the validity of these instruments be adequately demonstrated. This study sought to evaluate the concurrent validity of one disability measure, the Functional Independence Measure (FIM SM) using minutes of care reported by nursing staff. Study Design: Correlational, cohort design. Setting: Eight inpatient medical rehabilitation hospitals that subscribe to the Uniform Data System for Medical Rehabilitation. Patients or Other Participants: 129 patients with traumatic brain injury (TBI) and 53 patients with traumatic spinal cord injury (SCI). Interventions: Routine rehabilitation care. Main Outcome Measures: Patient-nurse contact times were recorded with a stop watch for a 24-hour period during the first and last weeks of inpatient rehabilitation. The FIM was also completed during the first and last weeks of rehabilitation. Results: Contact times declined from the first to last weeks of rehabilitation, concurrent with improving scores on motor and cognitive measures derived from the FIM. Statistically significant correlations between contact times and FIM measures were observed for medication dispensing, treatment provision, and teaching/activities of daily living at admission and discharge. Smaller and usually nonsignificant correlations were observed in activities that did not involve direct patient contact. Contact times increased exponentially as disability increased. Conclusions: These results support the construct validity of the FIM by demonstrating strong relationships (r values in the range of .40 to .60) between burden of care and a measure of disability.